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Mbwambo GA, van Zwetselaar M, Sonda T, Lukambagire AS, Njau JS, Wadugu B, Ignass IP, Amani NB, Hugho EA, Rubach MP, Sakasaka P, Oisso RS, Mkenda N, Shirima G, Ashford RT, Haydon DT, Maro VP, Kazwala RR, Kumburu HH, Mmbaga BT, Halliday JEB. Complete genome sequence of Brucella abortus isolated from a human blood culture sample in Tanzania. Microbiol Resour Announc 2024; 13:e0093023. [PMID: 38289053 PMCID: PMC10871059 DOI: 10.1128/mra.00930-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
Brucella abortus causes infections in humans and livestock. Bacterial isolates are challenging to obtain, and very little is known about the genomic epidemiology of this species in Africa. Here, we report the complete genome sequence of a Brucella abortus isolate cultured from a febrile human in northern Tanzania.
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Affiliation(s)
| | | | - Tolbert Sonda
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Judith S. Njau
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Boaz Wadugu
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | | | - Ephrasia A. Hugho
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Matthew P. Rubach
- Department of Medicine, Division of Infectious Disease and International Health, Duke Global Health Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Rose S. Oisso
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Gabriel Shirima
- Nelson Mandela Africa Institute of Science and Technology, Arusha, Tanzania
| | - Roland T. Ashford
- Department of Bacteriology, Animal and Plant Health Agency, Weybridge, United Kingdom
| | - Daniel T. Haydon
- School of Biodiversity, One Health & Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Venance P. Maro
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rudovick R. Kazwala
- Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Happiness H. Kumburu
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jo E. B. Halliday
- Department of Bacteriology, Animal and Plant Health Agency, Weybridge, United Kingdom
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Hugho EA, Kumburu HH, Thomas K, Lukambagire AS, Wadugu B, Amani N, Kinabo G, Hald T, Mmbaga BT. High diversity of Salmonella spp. from children with diarrhea, food, and environmental sources in Kilimanjaro - Tanzania: one health approach. Front Microbiol 2024; 14:1277019. [PMID: 38235427 PMCID: PMC10793262 DOI: 10.3389/fmicb.2023.1277019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024] Open
Abstract
Salmonella is one of the most frequent causes of diarrhea globally. This study used a One Health approach to identify Salmonella species in children admitted with diarrhea and tested samples from the cases' household environment to investigate their genetic similarity using whole genome sequencing. Surveillance of hospitalized diarrhea cases among children under 5 years was conducted in rural and urban Moshi Districts in the Kilimanjaro Region of Tanzania from July 2020 through November 2022. Household visits were conducted for every child case whose parent/caregiver provided consent. Stool samples, water, domestic animal feces, meat, and milk were collected and tested for Salmonella. Isolates were sequenced on the Illumina NextSeq platform. Multilocus Sequence Typing and phylogenetic analyses were performed to map the genetic relatedness of the isolates. Salmonella was isolated from 72 (6.0%) of 1,191 samples. The prevalence of Salmonella in children with diarrhea, domestic animal feces, food, and water was 2.6% (n = 8/306), 4.6% (n = 8/174), 4.2% (n = 16/382), and 17.3% (n = 39/225), respectively. Four (1.3%) of the 306 enrolled children had a Salmonella positive sample taken from their household. The common sequence types (STs) were ST1208, ST309, ST166, and ST473. Salmonella Newport was shared by a case and a raw milk sample taken from the same household. The study revealed a high diversity of Salmonella spp., however, we detected a Salmonella clone of ST1208 isolated at least from all types of samples. These findings contribute to understanding the epidemiology of Salmonella in the region and provide insight into potential control of foodborne diseases through a One Health approach.
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Affiliation(s)
- Ephrasia A. Hugho
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Happiness H. Kumburu
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
- Department of Biochemistry, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kate Thomas
- Ministry of Primary Industries, New Zealand Food Safety, Wellington, New Zealand
| | | | - Boaz Wadugu
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
| | - Nelson Amani
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
| | - Grace Kinabo
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
- Department of Pediatrics, Christian Medical Center, Kilimanjaro, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Tine Hald
- Research Group for Genomic Epidemiology, Technical University of Denmark, Lyngby, Denmark
| | - Blandina T. Mmbaga
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
- Department of Pediatrics, Christian Medical Center, Kilimanjaro, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Kumburu HH, Shayo M, van Zwetslaar M, Njau J, Kuchaka DJ, Ignas IP, Wadugu B, Kasworm R, Masaki LJ, Hallgren MB, Clausen PT, Mmbaga BT, Aarestrup FM, Sonda TB. Nanopore sequencing technology for clinical diagnosis of infectious diseases where laboratory capacity is meager: A case report. Heliyon 2023; 9:e17439. [PMID: 37539288 PMCID: PMC10395014 DOI: 10.1016/j.heliyon.2023.e17439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/29/2023] [Accepted: 06/16/2023] [Indexed: 08/05/2023] Open
Abstract
In resource-limited settings, patients are often first presented to clinical settings when seriously ill and access to proper clinical microbial diagnostics is often very limited or non-existing. On February 16th, 2022 we were on a field trip to test a completely field-deployable metagenomics sequencing set-up, that includes DNA purification, sequencing, and bioinformatics analyses using bioinformatics tools installed on a laptop for water samples, just outside Moshi, Tanzania. On our way to the test site, we were contacted by the nearby Machame hospital regarding a child seriously ill with diarrhea and not responding to treatment. Within the same day, we conducted an onsite metagenomics examination of a fecal sample from the child, and Campylobacter jejuni was identified as the causative agent. The treatment was subsequently changed, with almost immediate improvement, and the child was discharged on February 21st.
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Affiliation(s)
- Happiness H. Kumburu
- Kilimanjaro Christian Medical Centre (KCMC), Tanzania
- Kilimanjaro Clinical Research Institute (KCRI), Sokoine Road, P. O. Box. 2236, Moshi, Tanzania
- Kilimanjaro Christian Medical University College (KCMUCo), 2240 Moshi Kilimanajro, Tanzania
| | - Mariana Shayo
- Kilimanjaro Christian Medical University College (KCMUCo), 2240 Moshi Kilimanajro, Tanzania
| | - Marco van Zwetslaar
- Kilimanjaro Clinical Research Institute (KCRI), Sokoine Road, P. O. Box. 2236, Moshi, Tanzania
| | - Judith Njau
- Kilimanjaro Clinical Research Institute (KCRI), Sokoine Road, P. O. Box. 2236, Moshi, Tanzania
| | - Davis J. Kuchaka
- Kilimanjaro Clinical Research Institute (KCRI), Sokoine Road, P. O. Box. 2236, Moshi, Tanzania
- The Nelson Mandela African Institution of Science and Technology (NM-AIST), Tanzania
| | - Ignas P. Ignas
- Kilimanjaro Clinical Research Institute (KCRI), Sokoine Road, P. O. Box. 2236, Moshi, Tanzania
| | - Boaz Wadugu
- Kilimanjaro Clinical Research Institute (KCRI), Sokoine Road, P. O. Box. 2236, Moshi, Tanzania
| | | | | | | | | | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical Centre (KCMC), Tanzania
- Kilimanjaro Clinical Research Institute (KCRI), Sokoine Road, P. O. Box. 2236, Moshi, Tanzania
- Kilimanjaro Christian Medical University College (KCMUCo), 2240 Moshi Kilimanajro, Tanzania
| | | | - Tolbert B. Sonda
- Kilimanjaro Christian Medical Centre (KCMC), Tanzania
- Kilimanjaro Clinical Research Institute (KCRI), Sokoine Road, P. O. Box. 2236, Moshi, Tanzania
- Kilimanjaro Christian Medical University College (KCMUCo), 2240 Moshi Kilimanajro, Tanzania
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Hugho EA, Kumburu HH, Amani NB, Mseche B, Maro A, Ngowi LE, Kyara Y, Kinabo G, Thomas KM, Houpt ER, Liu J, Hald T, Mmbaga BT. Enteric Pathogens Detected in Children under Five Years Old Admitted with Diarrhea in Moshi, Kilimanjaro, Tanzania. Pathogens 2023; 12:pathogens12040618. [PMID: 37111504 PMCID: PMC10143310 DOI: 10.3390/pathogens12040618] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Despite the availability and wide coverage of rotavirus vaccinations in Tanzania, there is still a significant number of diarrhea cases being reported, with some patients requiring hospital admission. We investigated diarrhea-causing pathogens and determined the effect of co-infection on clinical symptoms. Total nucleic acid was extracted from archived stool samples (N = 146) collected from children (0-59 months) admitted with diarrhea in health facilities in Moshi, Kilimanjaro. Pathogen detection was performed using the quantitative polymerase chain reaction with custom TaqMan Array cards. The Poisson model was used to determine the effect of co-infection on clinical presentation during admission. Of all the participants, 56.85% were from rural Moshi with a median age of 11.74 months (IQR: 7.41-19.09). Vomiting (88.36%) and a fever (60.27%) were the most frequent clinical manifestations. At least one diarrhea-associated pathogen was detected in 80.14% (n = 117) of the study population. The most prevalent pathogens were rotavirus 38.36% (n = 56), adenovirus 40/41 19.86% (n = 29), Shigella/EIEC 12.33% (n = 18), norovirus GII 11.44% (n = 17) and Cryptosporidium 9.59% (n = 14). Co-infections were detected in 26.03% of the study population (n = 38). The presence of multiple pathogens in the stool samples of children with diarrhea indicates poor sanitation and may have significant implications for disease management and patient outcomes.
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Affiliation(s)
- Ephrasia A Hugho
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi 25102, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi 25102, Tanzania
| | - Happiness H Kumburu
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi 25102, Tanzania
| | - Nelson B Amani
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi 25102, Tanzania
| | - Bahati Mseche
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi 25102, Tanzania
| | - Athanasia Maro
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi 25102, Tanzania
| | - Lilian E Ngowi
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi 25102, Tanzania
| | - Yudathadei Kyara
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi 25102, Tanzania
| | - Grace Kinabo
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi 25102, Tanzania
- Department of Pediatrics, Kilimanjaro Christian Medical Centre, Moshi 25102, Tanzania
| | - Kate M Thomas
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi 25102, Tanzania
- Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand
- New Zealand Food Safety, Ministry of Primary Industries, Wellington 6011, New Zealand
| | - Eric R Houpt
- Division of infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22902, USA
| | - Jie Liu
- School of Public Health, Qingdao University, Qingdao 266073, China
| | - Tine Hald
- Research Group for Genomic Epidemiology, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Blandina T Mmbaga
- Biotechnology Research Laboratory, Kilimanjaro Clinical Research Institute, Moshi 25102, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi 25102, Tanzania
- Department of Pediatrics, Kilimanjaro Christian Medical Centre, Moshi 25102, Tanzania
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Mziray SR, Kumburu HH, Assey HB, Sonda TB, Mahande MJ, Msuya SE, Kiwelu IE. Patterns of acquired HIV-1 drug resistance mutations and predictors of virological failure in Moshi, Northern Tanzania. PLoS One 2020; 15:e0232649. [PMID: 32986709 PMCID: PMC7521739 DOI: 10.1371/journal.pone.0232649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022] Open
Abstract
Emergence of HIV drug resistance poses a serious risk of inactivity to all currently approved antiretroviral drugs. Profiles of HIV drug resistance mutations (HIVDRM) and virological failure (VF) are not extensively studied in Tanzania. This study aimed to determine HIVDRM and predictors of VF in HIV-infected individuals failing first-line HIV drugs in Moshi, Northern Tanzania. A case-control study was conducted at Kilimanjaro Christian Medical Centre, Mawenzi, Pasua and Majengo health facilities with HIV-care and treatment clinics from October, 2017 to August, 2018. Cases and controls were HIV-infected individuals with VF and viral suppression (VS) respectively. HIV-1 reverse transcriptase and protease genes were amplified and sequenced. Stanford University's HIV drug resistance database and REGA subtyping tool 3.0 determined HIVDRM and HIV-1 subtypes respectively. Odds ratios (OR) with 95% confidence interval (95% CI) investigated predictors of VF. P-value < 5% was considered statistically significant. A total of 124 participants were recruited, of whom 63 (50.8%) had VF, 61 (49.2%) had VS and 82 (66.1%) were females. Median [IQR] age and duration on ART were 45 [35-52] years and 72 [48-104] months respectively. Twenty-five out of 26 selected samples from cases were successfully sequenced. Twenty-four samples (96%) had at least one major mutation conferring resistance to HIV drugs, with non-nucleoside analogue reverse transcriptase inhibitor (NNRTI)-resistance associated mutations as the majority (92%). Frequent NNRTI-resistance associated mutations were K103N (n = 11), V106M (n = 5) and G190A (n = 5). Prevalent nucleoside analogue reverse transcriptase inhibitors-resistance associated mutations were M184V (n = 17), K70R (n = 7) and D67N (n = 6). Dual-class resistance was observed in 16 (64%) samples. Thirteen samples (52%) had at least one thymidine analogue-resistance associated mutation (TAM). Three samples (12%) had T69D mutation with at least 1 TAM. Two samples (8%) had at least one mutation associated with protease inhibitor resistance. Age [aOR = 0.94, 95% CI (0.90-0.97), p < 0.001] and occupation [aOR = 0.35, 95% CI (0.12-1.04), p = 0.059] associated with VF. In conclusion, HIV drug resistance is common among people failing antiretroviral therapy. Resistance testing will help to guide switching of HIV drugs.
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Affiliation(s)
- Shabani Ramadhani Mziray
- Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Medical Laboratory Services, Kibong’oto Infectious Diseases Hospital (KIDH), Siha, Kilimanjaro, Tanzania
| | | | - Hellen B. Assey
- Department of Medical Laboratory Services, Kibong’oto Infectious Diseases Hospital (KIDH), Siha, Kilimanjaro, Tanzania
| | - Tolbert B. Sonda
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Kilimanjaro, Tanzania
| | - Michael J. Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
| | - Sia E. Msuya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
| | - Ireen E. Kiwelu
- Department of Medical Laboratory Services, Kibong’oto Infectious Diseases Hospital (KIDH), Siha, Kilimanjaro, Tanzania
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Kilimanjaro, Tanzania
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Kumburu HH, Sonda T, van Zwetselaar M, Leekitcharoenphon P, Lukjancenko O, Mmbaga BT, Alifrangis M, Lund O, Aarestrup FM, Kibiki GS. Using WGS to identify antibiotic resistance genes and predict antimicrobial resistance phenotypes in MDR Acinetobacter baumannii in Tanzania. J Antimicrob Chemother 2020; 74:1484-1493. [PMID: 30843063 PMCID: PMC6524488 DOI: 10.1093/jac/dkz055] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 12/11/2018] [Accepted: 01/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background Reliable phenotypic antimicrobial susceptibility testing can be a challenge in clinical settings in low- and middle-income countries. WGS is a promising approach to enhance current capabilities. Aim To study diversity and resistance determinants and to predict and compare resistance patterns from WGS data of Acinetobacter baumannii with phenotypic results from classical microbiological testing at a tertiary care hospital in Tanzania. Methods and results MLST using Pasteur/Oxford schemes yielded eight different STs from each scheme. Of the eight, two STs were identified to be global clones 1 (n = 4) and 2 (n = 1) as per the Pasteur scheme. Resistance testing using classical microbiology determined between 50% and 92.9% resistance across all drugs. Percentage agreement between phenotypic and genotypic prediction of resistance ranged between 57.1% and 100%, with coefficient of agreement (κ) between 0.05 and 1. Seven isolates harboured mutations at significant loci (S81L in gyrA and S84L in parC). A number of novel plasmids were detected, including pKCRI-309C-1 (219000 bp) carrying 10 resistance genes, pKCRI-43-1 (34935 bp) carrying two resistance genes and pKCRI-49-1 (11681 bp) and pKCRI-28-1 (29606 bp), each carrying three resistance genes. New ampC alleles detected included ampC-69, ampC-70 and ampC-71. Global clone 1 and 2 isolates were found to harbour ISAba1 directly upstream of the ampC gene. Finally, SNP-based phylogenetic analysis of the A. baumannii isolates revealed closely related isolates in three clusters. Conclusions The validity of the use of WGS in the prediction of phenotypic resistance can be appreciated, but at this stage is not sufficient for it to replace conventional antimicrobial susceptibility testing in our setting.
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Affiliation(s)
- Happiness H Kumburu
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Tolbert Sonda
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | | | | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Lund
- DTU-Bioinformatics, Technical University of Denmark, Copenhagen, Denmark
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Dekker MCJ, Chengo R, Kumburu HH, Kamsteeg EJ, Hamel BC. Paroxysmal Kinesigenic Dyskinesia: First Molecularly Confirmed Case from Africa. Tremor Other Hyperkinet Mov (N Y) 2020; 10:tre-10-742. [PMID: 32002278 PMCID: PMC6982423 DOI: 10.7916/tohm.v0.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/05/2019] [Indexed: 12/01/2022]
Abstract
Background Paroxysmal kinesigenic dyskinesia (PKD) is a movement disorder, with an excellent response to carbamazepine treatment. It has been described in various populations, but not yet in an African population. Case report In a patient who reported to clinic with side effects of carbamazepine, PRRT2 gene screening was performed based on a clinical history compatible with PKD. A common PRRT2 mutation was identified in this patient, hereby the first genetically confirmed PRRT2-associated PKD in Africa. Discussion Reporting genetic confirmation of an unusual movement disorder from an equally unusual location shows the wide geographical distribution of PRRT2-associated disease. It also illustrates recognizability of this treatable disorder where the easiest accessible diagnostic tool is neurological history and examination.
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Affiliation(s)
- Marieke C J Dekker
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, TZ
| | - Rose Chengo
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, TZ
| | - Happiness H Kumburu
- Genomics and Bioinformatics Unit, Kilimanjaro Clinical Research Institute Biotechnology Laboratory, Kilimanjaro Christian Medical Centre, Moshi, TZ
| | - Erik-Jan Kamsteeg
- Department of Human Genetics, Radboud University Medical Center, GA Nijmegen, NL
| | - Ben C Hamel
- Department of Human Genetics, Radboud University Medical Center, GA Nijmegen, NL
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Sonda TB, Horumpende PG, Kumburu HH, van Zwetselaar M, Mshana SE, Alifrangis M, Lund O, Aarestrup FM, Chilongola JO, Mmbaga BT, Kibiki GS. Ceftriaxone use in a tertiary care hospital in Kilimanjaro, Tanzania: A need for a hospital antibiotic stewardship programme. PLoS One 2019; 14:e0220261. [PMID: 31381579 PMCID: PMC6681960 DOI: 10.1371/journal.pone.0220261] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022] Open
Abstract
Excessive use of antibiotics, especially watch group antibiotics such as ceftriaxone leads to emergence and spread of antimicrobial resistance (AMR). In low and middle-income countries (LMICs), antibiotics are overused but data on consumption is scarcely available. We aimed at determining the extent and predictors of ceftriaxone use in a tertiary care university teaching hospital in Kilimanjaro, Tanzania. A hospital-based cross-sectional study was conducted from August 2013 through August 2015. Patients admitted in the medical, surgical wards and their respective intensive care units, receiving antimicrobials and other medications for various ailments were enrolled. Socio-demographic and clinical data were recorded in a structured questionnaire from patients' files and logistic regression was performed to determine the predictors for ceftriaxone use. Out of the 630 patients included in this study, 322 (51.1%) patients were on ceftriaxone during their time of hospitalization. Twenty-two patients out of 320 (6.9%) had been on ceftriaxone treatment without evidence of infection. Ceftriaxone use for surgical prophylaxis was 44 (40.7%), of which 32 (72.7%) and 9 (20.5%) received ceftriaxone prophylaxis before and after surgery, respectively. Three (6.8%) received ceftriaxone prophylaxis during surgery. Predicting factors for that the health facility administered ceftriaxone were identified as history of any medication use before referral to hospital [OR = 3.4, 95% CI (1.0-11.4), p = 0.047], bacterial infection [OR = 18.0, 95% CI (1.4-225.7, p = 0.025)], surgical ward [OR = 2.9, 95% CI (0.9-9.4), p = 0.078] and medical wards [OR = 5.0, 95% CI (0.9-28.3), p = 0.070]. Overall, a high ceftriaxone use at KCMC hospital was observed. Antimicrobial stewardship programs are highly needed to monitor and regulate hospital antimicrobial consumption, which in turn could help in halting the rising crisis of antimicrobial resistance.
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Affiliation(s)
- Tolbert B. Sonda
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Pius G. Horumpende
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Lugalo General Military Hospital, Military College of Medical Sciences, Dar es Salaam, Tanzania
| | - Happiness H. Kumburu
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Marco van Zwetselaar
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Michael Alifrangis
- Centre for Medical Parasitology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Lund
- Centre for Biological Sequence Analysis, Technical University of Denmark; Copenhagen, Denmark
| | - Frank M. Aarestrup
- Centre for Genomic Epidemiology, Technical University of Denmark; Copenhagen, Denmark
| | - Jaffu O. Chilongola
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Horumpende PG, Said SH, Mazuguni FS, Antony ML, Kumburu HH, Sonda TB, Mwanziva CE, Mshana SE, Mmbaga BT, Kajeguka DC, Chilongola JO. Prevalence, determinants and knowledge of antibacterial self-medication: A cross sectional study in North-eastern Tanzania. PLoS One 2018; 13:e0206623. [PMID: 30379961 PMCID: PMC6209340 DOI: 10.1371/journal.pone.0206623] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/16/2018] [Indexed: 11/19/2022] Open
Abstract
Self-medication is very common especially in developing countries and is documented to be associated with many health risks including antibiotic resistance. This study investigated the prevalence, determinants and knowledge of self-medication among residents of Siha District in Tanzania. A cross-sectional study was conducted among 300 residents in a rural District of Kilimanjaro region, North-eastern Tanzania from 1st to 28th April 2017. A semi-structured questionnaire was used to collect information regarding drugs used, knowledge, history and reasons for antibiotic self-medication. Log—binomial regression analysis was done using STATA 13 to examine factors associated with self-medication. A slightly majority of the respondents (58%) admitted to self-medication. Antibiotics most commonly utilized were amoxycillin (43%) and an antiprotozoal drug metronidazole (10%). The most common symptoms that led to self-medication were cough (51.17%), headache/ fever/ malaria (25.57%) and diarrhoea (21.59%). The most common reasons for self-medication were emergency illness (24.00%), health facility charges (20.33%), proximity of pharmacy to home (17.00%) and no reason (16.66%). Almost all reported that self-medication is not better than seeking medical consultation, 98% can result into harmful effects and 96% can result to drug resistance. The level of self-medication in this study is comparable with findings from other studies in developing countries. Pharmacies were commonly used as the first point of medical care. There is therefore a need for educative antibiotic legislative intervention to mitigate the adverse effects of antibiotic self-medication in Siha district in Tanzania.
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Affiliation(s)
- Pius G. Horumpende
- Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
- Department of Preventive Medicine and Research, Lugalo General Military Hospital, Dar es Salaam, Tanzania
- * E-mail:
| | - Sophia H. Said
- Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Festo S. Mazuguni
- Department of Public Health and Research, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Magreth L. Antony
- Department of Parasitology and Entomology, National Health Laboratory Quality Assurance and Training Centre, Dar es Salaam, Tanzania
| | - Happiness H. Kumburu
- Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
| | - Tolbert B. Sonda
- Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
| | - Charles E. Mwanziva
- Department of Preventive Medicine and Research, Lugalo General Military Hospital, Dar es Salaam, Tanzania
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Blandina T. Mmbaga
- Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Debora C. Kajeguka
- Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Jaffu O. Chilongola
- Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
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Mpagama SG, Heysell SK, Ndusilo ND, Kumburu HH, Lekule IA, Kisonga RM, Gratz J, Boeree MJ, Houpt ER, Kibiki GS. Diagnosis and interim treatment outcomes from the first cohort of multidrug-resistant tuberculosis patients in Tanzania. PLoS One 2013; 8:e62034. [PMID: 23675411 PMCID: PMC3652861 DOI: 10.1371/journal.pone.0062034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 03/15/2013] [Indexed: 11/19/2022] Open
Abstract
Setting Kibong’oto National Tuberculosis Hospital (KNTH), Kilimanjaro, Tanzania. Objective Characterize the diagnostic process and interim treatment outcomes from patients treated for multidrug-resistant tuberculosis (MDR-TB) in Tanzania. Design A retrospective cohort study was performed among all patients treated at KNTH for pulmonary MDR-TB between November 2009 and September 2011. Results Sixty-one culture-positive MDR-TB patients initiated therapy, 60 (98%) with a prior history of TB treatment. Forty-one (67%) were male and 9 (14%) were HIV infected with a mean CD4 count of 424 (±106) cells/µl. The median time from specimen collection to MDR-TB diagnosis and from diagnosis to initiation of MDR-TB treatment was 138 days (IQR 101–159) and 131 days (IQR 32–233), respectively. Following treatment initiation four (7%) patients died (all HIV negative), 3 (5%) defaulted, and the remaining 54 (89%) completed the intensive phase. Most adverse drug reactions were mild to moderate and did not require discontinuation of treatment. Median time to culture conversion was 2 months (IQR 1–3) and did not vary by HIV status. In 28 isolates available for additional second-line drug susceptibility testing, fluoroquinolone, aminoglycoside and para-aminosalicylic acid resistance was rare yet ethionamide resistance was present in 9 (32%). Conclusion The majority of MDR-TB patients from this cohort had survived a prolonged referral process, had multiple episodes of prior TB treatment, but did not have advanced AIDS and converted to culture negative early while completing an intensive inpatient regimen without serious adverse event. Further study is required to determine the clinical impact of second-line drug susceptibility testing and the feasibility of alternatives to prolonged hospitalization.
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