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Manhique-Coutinho L, Chiani P, Michelacci V, Taviani E, Bauhofer AFL, Chissaque A, Cossa-Moiane I, Sambo J, Chilaúle J, Guimarães EL, Salência J, Cassocera M, Bero DM, Langa JP, de Deus N. Molecular characterization of diarrheagenic Escherichia coli isolates from children with diarrhea: A cross-sectional study in four provinces of Mozambique: Diarrheagenic Escherichia coli in Mozambique. Int J Infect Dis 2022; 121:190-194. [PMID: 35489634 DOI: 10.1016/j.ijid.2022.04.054] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 04/06/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Analyze the frequency of diarrheagenic Escherichia coli (DEC) pathotypes and their antimicrobial resistance profiles among children aged <15 years with diarrhea in four Mozambican provinces. METHODS A cross-sectional hospital-based surveillance program of diarrhea was implemented in Maputo, Sofala, Zambézia, and Nampula. A single stool sample was collected from each child from May 2014 to May 2017. Culture methods and biochemical characterization were performed to detect E. coli strains. DEC pathotypes were determined by conventional polymerase chain reaction targeting specific virulence genes. Antimicrobial susceptibility was assessed by the Kirby-Bauer method. RESULTS From 723 specimens analyzed by culture, 262 were positive for E. coli. A total of 208 samples were tested by polymerase chain reaction for DEC identification, of which 101 (48.6%) were positive for a DEC pathotype. The predominant pathotypes were enteroaggregative (66.3%, 67/101), enteropathogenic (15.8%, 16/101), enterotoxigenic (13.9%, 14/101), and enteroinvasive E. coli (4.0%, 4/101). No Shiga toxin-producing E. coli was identified. Regardless of the province, the most frequent pathotype was enteroaggregative E. coli. Isolated DEC presented high frequency of resistance to ampicillin (97.8%), tetracycline (68.3%), chloramphenicol (28.4%), nalidixic acid (19.5%), and gentamicin (14.4%). CONCLUSION Children with diarrhea in Mozambique had DEC and higher resistance to ampicillin and tetracycline.
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Affiliation(s)
- Lena Manhique-Coutinho
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Universidade Eduardo Mondlane, Maputo 3453, Mozambique.
| | - Paola Chiani
- Istituto Superiore di Sanità, Department of Food Safety, Nutrition and Veterinary Public Health, 299, 0161, Rome, Italy
| | - Valeria Michelacci
- Istituto Superiore di Sanità, Department of Food Safety, Nutrition and Veterinary Public Health, 299, 0161, Rome, Italy
| | - Elisa Taviani
- Universidade Eduardo Mondlane, Maputo 3453, Mozambique
| | - Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Assucênio Chissaque
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Idalécia Cossa-Moiane
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Institute of Tropical Medicine (ITM), 2000 Antwerp, Belgium
| | - Júlia Sambo
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Jorfélia Chilaúle
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique
| | - Esperança Lourenço Guimarães
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Judite Salência
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique
| | - Marta Cassocera
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Diocreciano Matias Bero
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique
| | - José Paulo Langa
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique
| | - Nilsa de Deus
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Universidade Eduardo Mondlane, Maputo 3453, Mozambique
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Bauhofer AFL, Cossa-Moiane I, Marques S, Guimarães EL, Munlela B, Anapakala E, Chilaúle JJ, Cassocera M, Langa JS, Chissaque A, Sambo J, Manhique-Coutinho L, Bero DM, Kellogg TA, de Deus N. Intestinal protozoan infections among children 0-168 months with diarrhea in Mozambique: June 2014 - January 2018. PLoS Negl Trop Dis 2020; 14:e0008195. [PMID: 32320399 PMCID: PMC7176080 DOI: 10.1371/journal.pntd.0008195] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 09/06/2019] [Accepted: 03/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intestinal parasites such as Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica can cause severe diarrhea, especially among children in developing countries. This study aims to determine the frequency of Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica in children with diarrhea and identify risk factors for infection. METHODOLOGY We conducted a cross-sectional study in children aged 0-168 months hospitalized with diarrhea in three regions of Mozambique, from June 2014 to January 2018. Following consent, caretakers were interviewed and a single stool specimen was collected from each child to diagnose Cryptosporidium spp., G. lamblia and E. histolytica using commercial immune-enzymatic assay (TechLab, Inc, Blacksburg, VA, USA). Anthropometric data were collected from the clinical reports. Multivariable logistic regression models were built to identify risk factors for Cryptosporidium spp. and G. lamblia infection. RESULTS Twenty-one percent of all specimens (212/1008) presented at least one parasitic infection. Cryptosporidium spp. infection was the most common 12.0% (118/985), followed by G. lamblia 9.7% (95/983) and E. histolytica 2.0% (20/1004). Risk factors for infection by Cryptosporidium spp. were: provenience (children from Nampula province showed the highest risk, OR: 8.176; CI: 1.916-34.894; p-value < 0.01); animal contact (children with animal contact had a protective effect OR: 0.627; CI: 0.398-0.986; p-value < 0.05); underweight (children severely underweight showed a risk of 2.309; CI: 1.310-4.069; p-value < 0.05). Risk factors for infection by G. lamblia were: age (group with highest risk, 60-168 months (OR: 2.322; CI: 1.000-5.393, p-value > 0.05)); and living in a household with five or more members (OR: 2.141; CI: 1.286-3.565, p-value < 0.01). CONCLUSIONS Parasitic infection is common among children with diarrhea. Routine testing, standard treatment, and assessment for risk exposure of children with diarrhea should be implemented at health facilities in Mozambique.
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Affiliation(s)
- Adilson Fernando Loforte Bauhofer
- Direcção de Formação e Comunicação em Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Idalécia Cossa-Moiane
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Selma Marques
- Direcção de Formação e Comunicação em Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Centro de Biotecnologia, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Esperança L. Guimarães
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
- Direcção de Pesquisa em Saúde e Bem-Estar, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Benilde Munlela
- Direcção de Formação e Comunicação em Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Centro de Biotecnologia, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Elda Anapakala
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Jorfélia J. Chilaúle
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Marta Cassocera
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
- Direcção de Pesquisa em Saúde e Bem-Estar, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Jerónimo S. Langa
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Assucênio Chissaque
- Direcção de Formação e Comunicação em Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Júlia Sambo
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
- Direcção de Pesquisa em Saúde e Bem-Estar, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Lena Manhique-Coutinho
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Diocreciano Matias Bero
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Timothy A. Kellogg
- Direcção de Inquéritos e Observação de Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Nilsa de Deus
- Direcção de Pesquisa em Saúde e Bem-Estar, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
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