Low anti tuberculosis drug resistance despite high rates of recurrent tuberculosis and HIV infection in western Kenya

Background: The high rates of recurrent tuberculosis and HIV in Kenya raised the assumption that anti -tuberculosis drug resistance may be an increasing problem. Objective: To determine whether HIV co infection and TB recurrence are associated with anti TB drug resistance. Methods: Cross sectional study in which sputa from 872 TB suspects underwent ZN smear microscopy and culture. Growth was identified using Hain molecular identification kits. Screening for HIV infection was done using Uni GoldTM rapid test and the positives confirmed with enzyme linked immunosorbent assay. Results: A total of 186 M. tuberculosis complex and 15 non tuberculous mycobacteria isolates were obtained. The tuberculosis recurrence and TB HIV co infection rates amounted to 44.8% and 41.8%, respectively. All the 186 M. tuberculosis isolates were susceptible to streptomycin and ethambutol. Only 12 (6.5%) of the isolates were mono drug resistant, nine to isoniazid and three to rifampicin. Only 3/27 isoniazid resistant isolates were from recurrent TB cases. Conclusion and recommendation: No MDR strains of M. tuberculosis were observed in the current study. However, the study suggests an association between HIV co-infection and anti TB mono drug resistance. High TB recurrence observed in the current study was not associated with anti TB drug resistance. What needs to be examined is the cause of this high TB recurrence rate in Western Kenya. Keywords: Recurrent TB; HIV co infection; antiTB drug resistance; prevalenc

Multidrug-resistant enteroaggregative Escherichia coli associated with persistent diarrhea in Kenyan children.

To study the association of multidrug-resistant enteroaggregative Escherichia coli with persistent diarrhea in Kenyan children, stool specimens were obtained from 862 outpatients under 5 years of age from July 1991 to June 1993. E. coli O44 was identified as the sole bacterial pathogen in four patients experiencing at least 14 days of fever, vomiting, and diarrhea. Disk diffusion testing showed E. coli O44 resistance to tetracycline, ampicillin, erythromycin, trimethoprim-sulphamethoxazole, and amoxicillin/clavulanate and sensitivity to chloramphenicol, nalidixic acid, azithromycin, and cefuroxime. Further studies are needed to clarify the epidemiology, clinical spectrum, and pathogenesis of enteroaggregative E. coli infection

Resistance of Klebsiella Species Isolates From Two Institutions in Nairobi, Kenya, to Commonly Prescribed Antimicrobial Agents

Klebsiella species isolates collected from the Kenyatta National Hospital and the Centre for Microbiology Research of the Kenya Medical Research Institute in Nairobi, Kenya were identified and screened for resistance to commonly prescribed antimicrobial agents. Most of the isolates were found to exhibit resistance to more than three agents amongst those tested by both disk diffusion tests and minimum inhibitory concentration determination. Keywords: Klebsiella , resistance, minimum inhibitory concentration, disk diffusion East and Central African Journal of Pharmaceutical Studies Vol. 10 (1) 2007: pp. 22-2

HIV co-infection with tuberculous and non-tuberculous mycobacteria in western Kenya: challenges in the diagnosis and management

Background: Tuberculosis (TB) and HIV co-infections have a global prevalence with devastating morbidity and massive mortality, Sub-Saharan Africa being the worst hit. Objectives: To evaluate the prevalence of TB-HIV co-infection and demonstrate the confusion caused by NTM and HIV/ AIDS co-infection in TB diagnosis and treatment in western Kenya. Methods: In a cross-sectional study carried out at 10 hospitals in western Kenya, sputa from consenting 872 TB suspects underwent microscopy, and culture on Lowenstein-Jensen and Mycobacteria Growth Index Tube media. Isolates were identified using the Hain’s GenoType® Mycobacterium CM and GenoType® Mycobacterium AS kits. A total of 695 participants were screened for HIV using Uni-GoldTM test and positives confirmed with the enzyme linked immunosorbent assay. Results: A total of 346 (39.7%) participants were diagnosed with TB. Out of the 346 TB cases, 263 (76%) were tested for HIV infection and 110 (41.8%) of these were sero-positive (co-infected). The female to male TB-HIV co-infection prevalence ratio (PR) was 1.35. This study reports isolation of non-tuberculous mycobacteria from TB suspects at a rate of 1.7%. Conclusion: A high TB-HIV co-infection rate was observed in this study. The NTM disease could be misdiagnosed and treated as TB in western Kenya

Side Effects of Praziquantel in the Treatment of Urinary Schistosomiasis in Kenya

Side effects of praziquantel in a single-dose treatment of urinary schistosomiasis at 40 mg/kg were studied on 174 subjects by means of questioning clinical manifestations before and　24 hr after treatment. The numbers of abdominal pain/discomfort, nausea/vomiting and dizziness/lassitude increased after treatment at a statistically significant level. "Possible" side reactions, defined as clinical manifestations developed newly or increased their degree of severity after treatment, were experienced by 55.7% of the treated people. Females suffered more nausea/vomiting than males, and people of age 16-20 years had reactions more frequently than the other ages. With a few exceptions, the adverse effects were mild and disappeared within 11 hr after their onset

Non-typhi salmonella in children with severe malaria.

OBJECTIVE: To determine the association between Plasmodium falciparum malaria and non-typhi Salmonella in children. DESIGN: Cross-sectional hospital based study. SETTING: Kilifi District Hospital (KDH) between January 1997 and June 2001. SUBJECTS: Children aged between three months to 123 months (mean age 28.28 months) and who had been admitted to the paediatric or High Dependency Research Ward (HDRW) of the KDH. METHODS: A total of 19, 118 blood cultures routinely obtained for all admissions and 1,820 clinically indicated stools samples were obtained from 9,147 children admitted with malaria. The specimens were cultured and antibiotic sensitivity done using standard laboratory procedures with stringent internal and external quality control in place. RESULTS: The total bacterial pathogens isolated from blood and stool were 1,395/19,118 (7.3%) and 342/1,820 (19%) respectively. Non-typhi salmonella consisted of 260/1,395 (18.6%) of the positive blood cultures and 92/324 (28.4%) of the stool cultures out of which a total of 101 NTS occurred in children with severe malaria. Out of the 9,147 malaria cases admitted, 101/9,147 (1.10%) had concomitant NTS infection. NTS with severe malaria as a proportion of all malaria admissions for the period varied between 0.8% and 1.5%. There was a significant association (p-value=0.032) between clinical outcome of death and female sex of the patient. The NTS isolates which occurred with severe malaria showed various levels of antibiotic resistance. They were resistant to ampicillin (35%), chloramphenicol (18%), gentamicin (22%), cefuroxime (29%), sulphamethoxazole-trimethoprim (39%), ciprofloxacin (3%), cefotaxime (14%), amoxycillin-clavulanic acid (26%) and tobramycin (18.0%). Multidrug resistance (MDR) was seen in 34 (33.6%) of the isolates. CONCLUSIONS: NTS and severe malaria occurring together are a problem in this area and that a large number of the isolates are MDR. An elaborate case-controlled study is required to elucidate the chain of events of both NTS and malaria parasite co-existence