Efficacy and Safety of Combined Bedaquiline and Delamanid Use among Patients with Multidrug-Resistant Tuberculosis in Beijing,China

Objectives The combined use of bedaquiline and delamanid(BDQ-DLM)is limited by an increased risk of prolonging the QTc interval.We retrospectively evaluated patients who received DLM/BDQcontaining regimens at a TB-specialized hospital.We aimed to present clinical efficacy and safety data for Chinese patients.Methods This case-control study included patients with multidrug-resistant tuberculosis(MDR-TB)treated with BDQ alone or BDQ plus DLM.Results A total of 96 patients were included in this analysis:64 in the BDQ group and 32 in the BDQ+DLM group.Among the 96 patients with positive sputum culture at the initiation of BDQ alone or BDQ combined with DLM,46 patients(71.9%)in the BDQ group and 29(90.6%)in the BDQ-DLM group achieved sputum culture conversion during treatment.The rate of sputum culture conversion did not differ between the two groups.The time to sputum culture conversion was significantly shorter in the BDQ-DLM group than in the BDQ group.The most frequent adverse event was QTc interval prolongation;however,the frequency of adverse events did not differ between the groups.Conclusion In conclusion,our results demonstrate that the combined use of BDQ and DLM is efficacious and tolerable in Chinese patients infected with MDR-TB.Patients in the BDQ-DLM group achieved sputum culture conversion sooner than those in the BDQ group.

Urea breath test for Helicobacter pylori infection in adult dyspeptic patients: A meta-analysis of diagnostic test accuracy

BACKGROUND Helicobacter pylori(H.pylori)infection has been well-established as a significant risk factor for several gastrointestinal disorders.The urea breath test(UBT)has emerged as a leading non-invasive method for detecting H.pylori.Despite numerous studies confirming its substantial accuracy,the reliability of UBT results is often compromised by inherent limitations.These findings underscore the need for a rigorous statistical synthesis to clarify and reconcile the diagnostic accuracy of the UBT for the diagnosis of H.pylori infection.AIM To determine and compare the diagnostic accuracy of 13C-UBT and 14C-UBT for H.pylori infection in adult patients with dyspepsia.METHODS We conducted an independent search of the PubMed/MEDLINE,EMBASE,and Cochrane Central databases until April 2022.Our search included diagnostic accuracy studies that evaluated at least one of the index tests(^(13)C-UBT or ^(14)C-UBT)against a reference standard.We used the QUADAS-2 tool to assess the methodo-logical quality of the studies.We utilized the bivariate random-effects model to calculate sensitivity,specificity,positive and negative test likelihood ratios(LR+and LR-),as well as the diagnostic odds ratio(DOR),and their 95%confidence intervals.We conducted subgroup analyses based on urea dosing,time after urea administration,and assessment technique.To investigate a possible threshold effect,we conducted Spearman correlation analysis,and we generated summary receiver operating characteristic(SROC)curves to assess heterogeneity.Finally,we visually inspected a funnel plot and used Egger’s test to evaluate publication bias.endorsing both as reliable diagnostic tools in clinical practice.CONCLUSION In summary,our study has demonstrated that ^(13)C-UBT has been found to outperform the ^(14)C-UBT,making it the preferred diagnostic approach.Additionally,our results emphasize the significance of carefully considering urea dosage,assessment timing,and measurement techniques for both tests to enhance diagnostic precision.Nevertheless,it is crucial for researchers and clinicians to evaluate the strengths and limitations of our findings before implementing them in practice.

Socio-environmental factors associated with small mammal assemblage and Leptospira prevalence in Suburban Areas of Terengganu,Malaysia

Objective:To examine the socio-environmental factors associated with the assemblage of small mammals and the prevalence of Leptospira pathogen in poor suburban communities of Terengganu,Malaysia.Methods:We trapped small mammals from 119 trapping points scattered around three suburban communities of Terengganu using sausage-baited live traps.On the average,we set up five traps for three nights at each sampling point during the trapping period.Kidneys of captured animals were harvested and processed for Leptospira investigation.Additionally,environmental survey was conducted at each trapping point to obtain information about possible variables supporting small mammal assemblage.We used a generalized linear model to evaluate the effect of different socio-environmental variables on small mammals’assemblage.Results:A total of 89 small mammals,specifically,Rattus norvegicus(n=39),Rattus rattus(n=27),Rattus exulans(n=10),Suncus murinus(n=11),and Tupaia glis(n=2)were captured from 1385 trap nights.Fourteen individuals(15.7%)of the captured animals tested positive for Leptospira bacteria using PCR detection.Results of our generalized linear model showed only residences bordering vacant lots as the variable positively associated with small mammal occurrence in the three study sites.Conclusions:Small mammal community,especially the often neglected species,could harbour and potentially contribute towards pathogenic Leptospira maintenance in the study sites.To adequately control small mammals’population and subsequent human zoonoses transmission,it is critical to advocate and promote appropriate infrastructure and suburban services,together with good hygiene practices that can reduce the animals’access to food and harborage.

Increased Incidence of Severe Adverse Events in Non-Small Cell Lung Cancer Patients with Previous Tuberculosis Episode Treated with PD-1 Inhibitors

Lung cancer is the top cause of cancer deaths globally.Advances in immune checkpoint inhibitors(ICIs)have transformed cancer treatment,but their use in lung cancer has led to more side effects.This study examined if past pulmonary tuberculosis(TB)affects ICIs’effectiveness and safety in lung cancer treatment.We reviewed lung cancer patients treated with ICIs at Beijing Chest Hospital from January 2019 to August 2022.

Preclinical and clinical evidence of the association of colibactinproducing Escherichia coli with anxiety and depression in colon cancer

BACKGROUND The association between the intestinal microbiota and psychiatric disorders is becoming increasingly apparent.The gut microbiota contributes to colorectal carcinogenesis(CRC),as demonstrated with colibactin-producing Escherichia coli(CoPEC).AIM To evaluate the association between CoPEC prevalence and anxiety-and depressive-like behaviors with both preclinical and clinical approaches.METHODS Patients followed after a CRC surgery and for whom the prevalence of CoPEC has been investigated underwent a psychiatric interview.Results were compared according to the CoPEC colonization.In parallel C57BL6/J wild type mice and mice with a CRC susceptibility were chronically infected with a CoPEC strain.Their behavior was assessed using the Elevated Plus Maze test,the Forced Swimming Test and the Behavior recognition system PhenoTyper®.RESULTS In a limited cohort,all patients with CoPEC colonization presented with psychiatric disorders several years before cancer diagnosis,whereas only one patient(17%)without CoPEC did.This result was confirmed in C57BL6/J wildtype mice and in a CRC susceptibility mouse model(adenomatous polyposis colimultiple intestinal neoplasia/+).Mice exhibited a significant increase in anxiety-and depressive-like behaviors after chronic infection with a CoPEC strain.CONCLUSION This finding provides the first evidence that CoPEC infection can induce microbiota-gut-brain axis disturbances in addition to its procarcinogenic properties.

Microbial Quality Assessment of Locally Produced Millet Drink “Lamugin” and Hibiscus sabdariffa Calyxes Extract Beverage “Sobolo” in Accra, Ghana

Local Ghanaian beverages such as Sobolo and Lamugin, play a significant cultural, economic, and medicinal role in the daily lives of the population. These traditional drinks are produced using locally sourced ingredients, making them both affordable and accessible. The COVID-19 pandemic further heightened the economic importance of these beverages, as demand surged due to their perceived immune-boosting properties. However, the production of these beverages often occurs in non-sterile environments with minimal regulatory oversight, leading to concerns about microbial contamination. This study aimed to evaluate the microbial quality of Sobolo and Lamugin sold at selected street markets in the Greater Accra region of Ghana. Samples were collected from various vendors and analyzed for bacterial and fungal pathogens using standard microbiological techniques. The results revealed significant microbial contamination in many samples, with bacteria such as Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae detected at levels exceeding safe limits. These findings raise serious public health concerns, as the consumption of contaminated beverages could lead to gastrointestinal infections and other health issues. This highlights the urgent need for stricter regulations and improved hygiene practices in the production of local beverages to ensure their safety for consumers. Implementing better regulatory frameworks, regular inspections, and public awareness campaigns could help mitigate the risks associated with these popular drinks, ensuring they remain a safe and cherished part of Ghana’s cultural heritage.

Excipient effect on antimicrobial activity of Cinnamon (Cinnamomum zelylanicum album) oil, Thyme (Thymus vulgaris) oil and Ajowan (Trachyspermum ammi) oil

Background:Many herbal essential oils are potential antimicrobials but their pharmaceutical utility is restricted due to a lack of suitable excipients to mollify their dermatotoxicity and irritant property,and outcome of their therapeutic use may vary with different diluents used.Methods:Effect of 16 diluents(dimethyl sulfoxide,liquid paraffin,glycerine,oils of mustard,sunflower,rice bran,palm,groundnut,olive,coconut,sesame,avocado,jojoba,castor,linseed and soybean)was assessed on antimicrobial activity of 2%cinnamon(Cinnamomum zelylanicum album),thyme(Thymus vulgaris)and ajowan(Trachyspermum ammi)oils using agar well diffusion assay.The effect of excipients was evaluated on six Candida albicans,five Escherichia coli,four Acinetobacter lwoffii,two strains each of Staphylococcus aureus,Enterobacter agglomerans,and Enterococcus faecium and one strain each of Acinetobacter calcoaceticus,Escherichia fergusonii,Klebsiella oxytoca,K.pneumoniae ssp.pneumoniae,Leclercia adecarboxylata,Paenibacillus amylolyticus,Proteus mirabilis,P.vulgaris,Pseudomonas aeruginosa,Raoultella terrigena,Staphylococcus capitis ssp.capitis,S.chromogenes,S.epidermidis,S.warneri and Streptococcus pyogenes.Results:Thyme oil(2%)maintained it antimicrobial activity on dilution in dimethyl sulfoxide and glycerine,and ajowan oil(2%)completely lost its antibacterial activity in all diluents except dimethyl sulfoxide.However,cinnamon oil partially lost its antimicrobial activity upon dilution in glycerine,vegetable,and mineral oils in comparison to dimethyl sulfoxide.Olive oil was the best vegetable oil,almost comparable to dimethyl sulfoxide and castor oil was the worst diluent for maintaining antimicrobial activity of cinnamon oil.Conclusion:The study indicated the non-suitability of vegetable oils for pharmaceutical formulations of essential oils except olive oil for dilution of cinnamon oil and glycerol for thyme oil to replace dimethyl sulfoxide as diluent.

Epidemiological, Diagnostic, Therapeutic, and Prognostic Profile of Non-Tuberculous Community-Acquired Purulent Pleurisy in Children at the Bouaké University Hospital Center, 2017-2021

Introduction: In Côte d’Ivoire, there is a scarcity of data on children’s purulent pleurisies. Objective: This study aims to elucidate the epidemiological, diagnostic, therapeutic, and evolutionary facets of non-tuberculous purulent pleurisies in pediatric patients. Methods: A retrospective analysis was conducted using the medical records of children aged one month to fifteen years with purulent pleurisies at Bouaké University Hospital Center from January 2017 to December 2021. Results: The study identified 124 cases of purulent pleurisies, constituting 18% of lower respiratory tract infections and 0.8% of all hospitalizations. The majority of these cases (69%) were in children between 1 and 24 months of age. Prominent symptoms included dyspnea (85.5%), O2 saturation below 95% in room air (76.6%), respiratory distress (68.5%), cutaneous-mucosal pallor (63.7%), and fever (43.5%). Radiological findings predominantly showed right-sided pleurisy (62.1%). The pleurisy was often extensive (78.2%), accompanied by pneumothorax (37.1%), alveolo-interstitial opacities (8.1% of cases), and abscess formations (1.6%). Pleural fluid cultures were positive in 46.9% of cases, with Staphylococcus aureus (75%, methi-S) identified among 32 bacteria. Initial antibiotic treatment was empirical, favoring oxacillin (53.2%) or amoxicillin-clavulanic acid (53.2%) in dual (42%) or triple therapy (33%) with gentamicin (64.1%) and/or metronidazole (21.8%). Treatments also included pleural drainage (68.5%) or repeated evacuation punctures (33.1%), and blood transfusion (39%). The mortality rate was 18.8%. Conclusion: Non-tuberculous purulent pleurisy remains a significant concern in pediatric hospitalizations at the CHU of Bouaké, marked by high mortality rates.

Epidemiology and Clinical Features of Mycobacterium avium Complex Pulmonary Disease in a Brazilian Amazon Cohort

The incidence of Mycobacterium avium complex pulmonary disease (MACPD) has been globally increasing. The present study aims to provide a comprehensive analysis of clinical characteristics and treatment response among patients in the Amazon region of Brazil and conduct a retrospective cohort study at a prominent referral hospital in the State of Par, Brazil, from 2012 to 2020. The M. avium group represented 58.9% of cases, followed by M. intracellulare (35.7%), M. colombiense (3.6%), and M. chimaera (1.8%). The majority of patients (73.2%) were female and with an average age of 63 years. Primary clinical manifestations included persistent cough and sputum production. The Charlson comorbidity index (CCI) averaged 2.47, with 36.3% of patients having a CCI score equal to higher than 3. Notably, over 70% of patients had received treatment for pulmonary tuberculosis before initiating treatment for MAC infection. The fibrocavitary radiologic form was the most prevalent (55.4%), frequently exhibiting a bilateral distribution (53.6%). Antimicrobial susceptibility revealed a significant prevalence of MAC resistance to drugs in the therapeutic regimen. Despite this, most of the patients experienced clinical improvement (50%). In conclusion, this study highlights a higher prevalence of MAC infections among middle-aged women, with a history of pulmonary tuberculosis treatment and presenting the fibrocavitary radiological form was predominant.

Phenotypic Characterization of Extended Spectrum Beta-Lactamase, Class C Cephalosporinase and Carbapenemase-Producing Klebsiella Species Isolated from Patients Consulted at Four Yaounde-Based Hospitals

Background: Klebsiella spp. are bacteria of medical importance for their role in opportunistic infections which are often difficult to treat because of resistance to one or several antimicrobials. The aim of this study was to determine antimicrobial resistance due to Extended Spectrum Beta-lactamase (ESBL), Class C cephalosporinase (AmpC) and carbapenemase enzymes in Klebsiella spp. isolated from patients consulted at four hospitals. Methodology: The study was cross-sectional and descriptive. A total of 4190 non-repetitive patients specimens from 13 types of clinical specimens were analysed from February to November 2020. Two hundred and twenty-five (225) Klebsiella spp isolates were identified using API 20E and antimicrobial susceptibility testing done according to the Kirby Bauer disc diffusion method. ESBL and AmpC phenotypes were determined by the combination disc method and carbapenemases by double disc synergy method, referenced by EUCAST guidelines for the resistance testing. Results: The frequency of the species was Klebsiella pneumoniae (69%, 155/255), K. oxytoca (14%, 31/255), K. ozaenae (12%, 27/225) and K. rhinoscleromatis (5%, 11/225). Isolates were most resistant to sulphomethoxazole trimethoprim (84%, 189/225), cepaholosporins (80%, 180/225), and least resistant to carbapenems (10.7%, 24/225). Two K. oxytoca and one K. pneumoniae were resistant to all antibiotics tested. Klebsiella pneumoniae had the most multidrug resistant isolates (59.4%, 134/225). Most isolates (83.6%, 188/225) expressed at least one enzyme, while 63.6% (143/225) of the isolates expressed at least two enzymes. Some isolates were ESBL (71.6%, 161/225), carbapenemase (10.7%, 24/225) and AmpC (6.6%, 15/225) producers. Three carbapenemases (Klebsiella pneumoniae carbapenemase-KPC, Metallo-Beta Lactamase-MBL and OXA-48) were detected. Conclusion: These results revealed that resistance of Klebsiella spp. to cephalosporins is high and this may be exacerbated by co-expression of AmpC and carbapenemases aggravating associated patient morbidity and mortality. Monitoring of antimicrobial resistance of local strains is necessary for informed decisions on empirical treatment. .

Immunoprophylaxis failure and vaccine response in infants born to mothers with chronic hepatitis B infection in Djibouti

BACKGROUND In endemic areas,vertical transmission of hepatitis B virus(HBV)remains a major source of the global reservoir of infected people.Eliminating mother-to-child transmission(MTCT)of HBV is at the heart of World Health Organization’s goal of reducing the incidence of HBV in children to less than 0.1%by 2030.Universal screening for hepatitis B during pregnancy and neonatal vaccination are the main preventive measures.AIM To evaluate the efficacy of HBV vaccination combined with one dose of immunoglobulin in children born to hepatitis B surface antigen(HBsAg)-positive mothers in Djibouti city.METHODS We conducted a study in a prospective cohort of HBsAg-positive pregnant women and their infants.The study ran from January 2021 to May 2022,and infants were followed up to 7 mo of age.HBV serological markers and viral load in pregnant women were measured using aVidas microparticle enzyme-linked immunosorbent assay(Biomérieux,Paris,France)and the automated Amplix platform(Biosynex,Strasbourg,France).All infants received hepatitis B immunoglobulin and were vaccinated against HBV at birth.These infants were closely monitored to assess their seroprotective response and for failure of immunoprophylaxis.Simple logistic regression was also used to identify risk factors associated with immunoprophylaxis failure and poor vaccine response.All statistical analyses were performed with version 4.0.1 of the R software.RESULTS Of the 50 pregnant women recruited,the median age was 31 years,ranging from 18 years to 41 years.The MTCT rate in this cohort was 4%(2/50)in HBsAg-positive women and 67%(2/3)in hepatitis B e antigen-positive women with a viral load>200000 IU/mL.Of the 48 infants who did not fail immunoprophylaxis,8(16%)became poor responders(anti-HB<100 mIU/mL)after HBV vaccination and hepatitis B immunoglobulin,while 40(84%)infants achieved a good level of seroprotection(anti-HB>100 mIU/mL).Factors associated with this failure of immunoprophylaxis were maternal HBV DNA levels(>200000 IU/mL)and hepatitis B e antigen-positive status(odds ratio=158,95%confidence interval:5.05-4958,P<0.01).Birth weight<2500 g was associated with a poor immune response to vaccination(odds ratio=34,95%confidence interval:3.01-383.86,P<0.01).CONCLUSION Despite a failure rate of immunoprophylaxis higher than the World Health Organization target,this study showed that the combination of immunoglobulin and HBV vaccine was effective in preventing MTCT of HBV.Therefore,further studies are needed to better understand the challenges associated with immunoprophylaxis failure in infants in Djibouti city.

Molecular Detection of Pathogens Involved in Sexually Transmitted Infections in Brazzaville, Congo

The objective of this multicentric study was to assess the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma génitalium and Trichomonas vaginalis infections in Brazzaville, in the Republic of Congo, using molecular methods. From January to December 2021, the sexually transmitted disease risk participants were recruited from six centers: The Association of Young HIV-Positive People of Congo, The Congolese Association for Family Welfare, The Association for Support to Vulnerable Groups, Talangaï hospital, Brazzaville university hospital (outpatient service) and the private clinic COGEMO (outpatient service). The real-time multiplex PCR was carried out to detect these pathogens. Each patient had at least one specimen (urine, urethral, anal and/or vaginal samples). The patients were considered infected when one of their samples was positive. 287 participants made of 227 women and 60 men were tested. The general prevalence of these infections was: Chlamydia trachomatis 2.79%, Neisseria gonorrhoeae 3.14%, Mycoplasma génitalium 3.45% and Trichomonas vaginalis 2.97. The prevalence rates according to sex were: C. trachomatis, M. génitalium, N. gonorrhea and T. vaginalis were 1.32%, 2.05%, 1.32% and 3.42% in women and 8.33%, 7.02%, 10% and 1.75% in men, respectively. Most infected patients were asymptomatic. Prevalence rates were higher in bisexual individuals, with the exception of T. vaginalis which showed higher prevalence in heterosexual patients. The bisexual and homosexual individuals represent a major public health problem in sexually active young adults, particularly among men having sex with men. These sexually transmitted infections are mainly asymptomatic, their diagnosis and management remain difficult in developing countries.

Sarcopenia in chronic viral hepatitis:From concept to clinical relevance

Although the frequency of metabolic risk factors for cirrhosis and hepatocellular carcinoma(HCC)is increasing,chronic hepatitis B(CHB)and chronic hepatitis C(CHC)remain the most relevant risk factors for advanced liver disease worldwide.In addition to liver damage,hepatitis B virus(HBV)and hepatitis C virus(HCV)infections are associated with a myriad of extrahepatic manifestations including mixed cryoglobulinaemia,lymphoproliferative disorders,renal disease,insulin resistance,type 2 diabetes,sicca syndrome,rheumatoid arthritislike polyarthritis,and autoantibody production.Recently,the list has grown to include sarcopenia.Loss of muscle mass or muscle function is a critical feature of malnutrition in cirrhotic patients and has been found in approximately 23.0%-60.0%of patients with advanced liver disease.Nonetheless,among published studies,there is significant heterogeneity in the aetiologies of hepatic diseases and measurement methods used to determine sarcopenia.In particular,the interaction between sarcopenia,CHB and CHC has not been completely clarified in a real-world setting.Sarcopenia can result from a complex and multifaceted virus-host-environment interplay in individuals chronically infected with HBV or HCV.Thus,in the present review,we provide an overview of the concept,prevalence,clinical relevance,and potential mechanisms of sarcopenia in patients with chronic viral hepatitis,with an emphasis on clinical outcomes,which have been associated with skeletal muscle loss in these patients.A comprehensive overview of sarcopenia in individuals chronically infected with HBV or HCV,independent of the stage of the liver disease,will reinforce the necessity of an integrated medical/nutritional/physical education approach in the daily clinical care of patients with CHB and CHC.

Antibiotic Susceptibility Patterns of Bacteria Associated with Sepsis among Hospitalized Patients in the Yaoundé University Teaching Hospital—Cameroon

Background and Objective: In developing countries, the steep increase in septicaemia cases is a major health problem that creates the biggest challenge for clinicians in the selection of appropriate antimicrobial agents. This is further complicated by the development of resistance in organisms to antimicrobial agents, which is the mainstay of treatment. The aim of this study was to determine the antimicrobial resistance patterns of bacterial isolates associated with sepsis among hospitalized patients including the detection of Methicillin Resistance Staphylococcus aureus (MRSA) and Extended Spectrum Beta lactamases (ESBLs). Methods: A cross-sectional study was carried out for 5 months at the Yaounde University Teaching Hospital. Bacterial species were isolated from 150 blood samples collected from hospitalized patients. Antimicrobial susceptibility testing was carried out using the Kirby-Bauer disc diffusion method. The isolates were tested for methicillin resistance and ESBLs. Results: The prevalence of septicaemia was 16% (24/150) among hospitalized patients. In our study, 75% (18/24) of infections were caused by Gram- negative and 25% (6/24) by Gram-positive bacteria. Klebsiella spp., Escherichia coli, and Staphylococcus aureus were the most common isolates. The antibiotic susceptibility patterns of the isolates showed that Gram-negative bacteria were highly resistant to Amoxicillin clavulanic acid and ceftriaxone while the Gram- positive bacteria were highly resistant to minocycline. Fifty percent (3/6) of the isolated S. aureus were methicillin-resistant and 27.8% (5/18) of the isolated Enterobacteriaceae were ESBLs producers. In multivariable logistic regression analysis, temperature above 37.9℃ (AOR = 4.455;95% Cl = 1.458 - 15.693;p = 0.033) and being under respiratory assistance (AOR = 4.311;95% Cl = 1.458 - 12.749;p = 0.008) were significantly associated with septicaemia. Conclusion: The Occurrence of multidrug-resistant strains in this study emphasizes the need for continuous surveillance in hospitals to detect resistant strains. Strict guidelines for antibiotic therapy and the implementation of infection control measures to reduce the increasing burden of antibiotic resistance are advocated.

Risk Factors and Prevalence of Mother to New-Born Transmission of Carbapenemase Producing Enterobacteriaceae in Two Hospitals in Yaounde, Cameroon

Background: In African countries, where the burden of neonatal sepsis is the highest, the spread of Carbapenemases Producing Enterobacteriaceae (CPE) in the community, potentially contributing to neonatal mortality, is a public health concern. The transmission routes are not well defined, particularly the possible key role played by pregnant women. The aim of this study was to understand the neonatal acquisition of CPE in Yaounde, Cameroon. Methods: A transversal analytical study was conducted in an urban area. Maternal stool samples during delivery and the first stool from their new-born were collected and cultured to isolate Enterobacteria. After isolation, characterization using API20E identification system, and antibiotic susceptibility testing were performed according to the Antibiogram Committee of the French Society of Microbiology. Carbapenemases detection was done on each carbapenem-resistant strain using the Modified Hodge Test (MHT) and their classification using the synergy tests with different inhibitors. Results: Out of the 55 CPE isolates identified, Escherichia coli was the most encountered bacteria both in mothers (n = 18, 50.00%) and infants (n = 11, 57.89%). Class B and D carbapenemases were found both in mothers and infants. The estimated prevalence of vertical transmission in our study, was 10% (n = 12). Logistic regression showed that CPE carriage in mothers and CPE acquisition in their new-borns were independently associated with the presence of greenish amniotic fluid (OR = 7.33, p 0.0001 in mothers and OR = 4.09, p = 0.0086 in new-borns). Conclusion: Our results highlight the non-negligeable role played by pregnant women in the neonatal acquisition of CPE.

Phenotypic Characterization of Carbapenemase-Producing Enterobacteriaceae Strains in a Referral Teaching Hospital in Yaoundé, Cameroon

Background: Carbapenemase-producing Enterobacteriaceae (CPE) are an important and increasing threat to global health. They are nowadays more encountered routinely in hospitals and cause high morbidity and mortality due to limited therapeutic alternatives. This study sought to determine the prevalence of CPE in Yaoundé teaching hospital, Cameroon, and the associated risk factors. Materials and Method: To achieve this goal, a descriptive cross-sectional study coupled to an analytical component with consecutive collection of Enterobacteria strains was carried out during a three-month period (from 27th July to 24th October 2018) in the University Teaching Hospital of Yaoundé, Cameroon. The oxidase and biochemical identification tests using a miniaturized Api 20 E system were performed on colonies grown on Eosin Methylene Blue (EMB) medium and subcultured on nutrient agar. Drug susceptibility testing was carried out according to the Antibiogram Committee of the French Society of Microbiology (CA-SFM 2018.V.2.0). The detection of carbapenemase production was performed by the CA-SFM 2018 algorithm for the screening of carbapenemase-producing enterobacteriaceae and its classification by inhibitory synergy tests. Results: Out of the 104 isolates, Escherichia coli (50%) was the most prevalent species, followed by Klebsiella pneumoniae (37.5%) and Citrobacter frendii (12.5%). Drugs susceptibility patterns showed a high resistance to penicillins group (97.4% to amoxicillin), cephalosporins (68.4% to cefotaxim, 58.1% to cefixim, 60.7% to ceftazidim, 57.1% of cefoxitin) and aztreonam (55.7%). However, 11.9% carbapenems related resistance was noticed: 14.4% to imipenem, 13.8% to ertapenem and 7.5% to meropenem. Numerous co-resistance to quinolones (65.8%), fluoroquinolones (49.6%), aminoglycosides (49.6%) and cotrimoxazole (71.8%) were also observed. From 104 isolates, AmpC production represented 23.08% (25/104) and 36.54% (38/104) were ESBL-isolates. The overall prevalence of CPE was 25% (26/104) with K.pneumoniae predominant (61.53%). Besides, Class A and class B carbapenemase were mainly produced with respectively 20% (21/104) and 5% (5/104). Univariate analysis revealed a significant association of carbapenemase production to Klebsiella pneumoniae (p = 0.01), ESBL and AmpC production ((P = 0.01 and P = 0.001 respectively) while that association was only significant to Klebsiella spp (p = 0.04) and AmpC production (p = 0.02) in multivariate analysis. Conclusion: The multi-resistance of Enterobacteriaceae to antibiotics in Cameroon has considerably increased. More attention should be paid to those bacteria to stall antimicrobial resistance spread.

Missed Opportunities for Diagnosing Bacilliferous Pulmonary Tuberculosis by Optical Microscopy versus GeneXpert MTB/RIF in Endemic Areas

Objective: To assess the missed opportunities from the diagnosis of bacilliferous pulmonary tuberculosis by optical microscopy compared to GeneXpert MTB/RIF between 2015 and 2019. Methods: This is a retrospective analysis of the diagnostic results of bacilliferous pulmonary tuberculosis in patients suspected of pulmonary tuberculosis at their first episode during the period. GeneXpert MTB/RIF (GeneXpert) and optical microscopy (OM) after Ziehl-Neelsen stained smear were performed on each patient’s sputum or gastric tubing fluid sample. Results: Among 341 patients suspected of pulmonary tuberculosis, 229 patients were declared bacilliferous tuberculosis by the two tests (67%), 220 patients by GeneXpert and 95 patients by OM, i.e. 64.5% versus 28% (p i.e. 58.5% of the positive cases detected by the two tests (134/229 patients) and 39.3% of the patients suspected of tuberculosis (134/341 patients). On the other hand, among 95 patients declared positive by OM, the GeneXpert ignored 9 (9.5%), i.e. 4% of all the positive cases detected by the two diagnostic tests (9/229 patients) and 3% of the patients suspected of tuberculosis (9/341 patients). The differences observed between the results of the two tests were statistically significant at the 5% threshold (p Conclusion: This study reveals missed diagnostic opportunities for bacilliferous pulmonary mycobacteriosis, statistically significant with optical microscopy than GeneXpert. The GeneXpert/optical microscopy couple could be a good contribution to the strategies for the elimination of pulmonary tuberculosis in sub-Saharan Africa.

Correction to“Performance of a serological IgM and IgG qualitative test for COVID-19 diagnosis:An experimental study in Brazil”

Correction to“Freire de Melo F,Martins Oliveira Diniz L,Nélio Januário J,Fernando Gonçalves Ferreira J,Dórea RSDM,de Brito BB,Marques HS,Lemos FFB,Silva Luz M,Rocha Pinheiro SL,de Magalhães Queiroz DM.Performance of a serological IgM and IgG qualitative test for COVID-19 diagnosis:An experimental study in Brazil.World J Exp Med 2022;12(5):100-103[PMID:36196438 DOI:10.5493/wjem.v12.i5.100]”.In this article,we identified an issue with the“Acknowledgments”section.Here,we then provide a recognition section for our supporting institutions.

Antibiotic Resistance in the Uropathogenic Enterobacteria Isolated from Patients Attending General Reference Hospital (GRH) of Niamey, Niger

Background: Urinary tract infections (UTIs) are a frequent reason for consultation and lead to a significant and sometimes inappropriate prescription of antibiotics. The latter favors antibiotic resistance and an increase in mortality as well as the cost of treatment. The present study aims to contribute to the fight against antibiotic resistance of enterobacteria. Methods: This is a prospective study from January to December, 2021 in the Microbiology laboratory of the General Reference Hospital (GRH) of Niamey including 3369 urine samples. The antibiotic resistance of enterobacteria was determined using the Viteck-2 method. Results: At least 280 strains of Enterobacteriaceae were isolated from the patient’s urine. Among these strains, Escherichia coli was the most predominant (74.64%), followed by Klebsiella pneumoniae (16.07%) and Enterobacter cloacae (7.14%) and other enterobacteria 2.15%. These Enterobacteriaceae are more common in community patients than in hospitalized patients. The average age of patients is 52 years and the age group most affected by these enterobacteria is 46 - 60 years (23.33%). The female sex is the most affected sex with (51.07%) against (48.97%) for the male sex with 1.04 as sex ratio. The hospitalization departments most affected by these enterobacteria are Nephrology (29.23%) and Endocrinology (21.54%). Up to 75% of the Enterobacteriaceae isolates show high resistance to ampicillin, amoxicillin-clavulanic acid, ticarcillin, piperacillin-tazobactam, cefoxitin, cefixime, ceftazidime, ceftriaxone, cotrimoxazole, nalidixic acid and ofloxacin. Conclusion: The high rate of antibiotic resistance among enterobacteria in urine is of concern. Only a few Enterobacteriaceae show low resistance to ertapenem, imipenem, amikacin, gentamicin, fosfomycin and nitrofurantoin. Therefore, these antibiotics are recommended as first line treatment for urinary tract infections.

Can the Urine Dipstick Test Be an Alternative in the Screening of Urinary Tract Infections for Inpatients in the Context of a Low-Income Country?

Background: Urinary Tract Infection (UTI), a prevalent bacterial infection in adults, heavily relies on cytobacteriological examination of urine (CBEU) for diagnosis. However, in resource-limited countries, accessibility to CBEU remains hindered by cost and availability. This study aims to assess the utility of the Urinary Dipstick Test (UDT) in diagnosing UTIs among hospitalized patients in the context of limited resources. Methods: A cross-sectional study was conducted from February to May 2019, encompassing hospitalized patients who underwent CBEU at the bacteriology unit of Sour? Sanou University Hospital. UDT and CBEU were concurrently performed, and UDT’s analytical and diagnostic performance was evaluated against CBEU, considered the gold standard. Results: A total of 274 CBEU requests were registered, involving 274 patients (159 males) with a mean age of 45.8 ± 21.3 years (ranging from 1 to 90 years). UTI was confirmed in 90 patients, yielding a frequency of 32.85%. The UTI bacteriological profile was dominated by Enterobacteriaceae (75.23%), primarily Escherichia coli (60.55%). Nitrite and Leukocytes were positive in 54 (19.8%) and 157 (53.6%) of the samples tested. Among patients with confirmed UTI, Nitrite, and Leukocytes were positive in 30 (33%) and 71 (79%) patients respectively. UDT demonstrated variable performance based on nitrite and leukocyte combination: Sensitivity (57%-82%), Specificity (7%-98%), Positive Predictive Value (PPV) (43%-57%), Negative Predictive Value (NPV) (43%-67%). UDT performed slightly better in women (NPV = 88%) and inpatients without urinary catheters (NPV = 75% and PPV = 80%). Conclusion: This study underscores UDT’s potential utility in excluding UTIs among women, younger patients, and inpatients without urinary catheters, albeit with limited confidence. The UDT emerges as a complementary tool for UTI screening, particularly in resource-limited settings.