Pathology Commons^™

Addressing The Shortage Of Pathologists In Africa: Creation Of A Mmed Programme In Pathology In Zambia, Victor Mudenda, Evans Malyangu, Shahin Sayed, Kenneth Fleming

Pathology, East Africa

Background: With approximately one pathologist for one million people compared to ratios of approximately 1 to 25 000 in the United States and United Kingdom, there is a severe shortage of pathologists in much of Africa. The situation is particularly severe in Zambia, where, in 2009, the ratio was 1 to 1.4 million.

Objective: To address this, a postgraduate Master of Medicine (MMed) training programme was launched in Lusaka in 2011.

Methods: The process and most significant challenges and lessons learned were documented, as they may be of value to other countries facing similar challenges.

Results: …

Establishing The College Of Pathologists Of East, Central And Southern Africa – The Regional East Central And Southern Africa College Of Pathology, Shahin Sayed, Rudo Mutasa, Ephata Kaaya, Victor Mudenda, Erasmus Rajiv, Edda Vuhahula, Jamilla Rajab, Robert Lukande, Edwin Walong, Angela Mutuku, Kenneth Fleming

Pathology, East Africa

Issues: The scarcity of pathologists in sub-Saharan Africa is a well established fact that is attributable to few training programmes in the region; this is further compounded by the lack of harmonised curricula, training and exams within and without member countries.

Description of the intervention: Through the Association of Pathologists of East, Central and Southern Africa, the College of Pathologists of East, Central and Southern Africa (COPECSA) was formed with the clear-cut goal of establishing a regional and internationally recognised college to support and inform good quality medical and laboratory practice by promoting leadership, mentorship and excellence in the safe …

Prognosticating Covid-19: A Need For Africa-Specific Laboratory Predictors, Geoffrey Omuse, Janet Maranga, Abubakar Abdillah, Daniel Maina

Pathology, East Africa

No Abstract

Combating Antibiotic Resistance Using Guidelines And Enhanced Stewardship In Kenya: A Protocol For An Implementation Science Approach, Jesse Gitaka, Moses Kamita, Dominic Mureithi, Davies Ndegwa, Moses Masika, Geoffrey Omuse, Moses Ngari, Francis Makokha, Peter Mwaura, Ronald Mathai, Francis Muregi, Matilu Mwau

Pathology, East Africa

Introduction: Antimicrobial resistance (AMR) is a growing problem globally especially in Sub-Saharan Africa including Kenya. Without any intervention, lower/middle-income countries (LMICs) will be most affected due to already higher AMR levels compared with higher income countries and due to the far higher burden of diseases in the LMICs. Studies have consistently shown that inappropriate use of antimicrobials is the major driver of AMR. To address this challenge, hospitals are now implementing antibiotic stewardship programmes (ASPs), which have been shown to achieve reduced antibiotic usage, to decrease the prevalence of resistance and lead to significant economic benefits. However, the implementation of …

Point-Of-Care Hpv Molecular Diagnostics For A Test-And-Treat Model In High-Risk Hiv Populations, Shahin Sayed, Michael Chung, Marleen Temmerman

Pathology, East Africa

Strategies for cervical cancer prevention and control in low-income and middle-income countries (LMICs) require concerted efforts to improve screening and access to treatment, especially in high-risk HIV populations. LMICs bear the largest burden of HIV infection, human papillomavirus (HPV) infection is common among HIV-infected women, risk of cervical cancer is increased in women with HIV/AIDS, and HIV clinics provide opportunities to screen and treat for cervical cancer in this population.

Xpert® Mtb/Rif Assay On Formalin-Fixed Paraffin-Embedded Tissues In The Diagnosis Of Extrapulmonary Tuberculosis, Allan Njau, Samuel Gakinya, Shahin Sayed, Zahir Moloo

Pathology, East Africa

Background: Diagnosis of extrapulmonary tuberculosis continues to be a challenge due to the complexity of the causative organism and the wide array of pathologic features seen in this infection. Xpert MTB/RIF can be used on fresh or frozen tissue specimens for diagnosis of tuberculosis with good results. However, there is little data on its use with formalin-fixed paraffin-embedded (FFPE) tissues.

Objectives: The aim of this study was to demonstrate the potential utility of Xpert MTB/RIF and to compare its performance to Ziehl-Neelsen staining for the detection of Mycobacterium tuberculosis from FFPE tissues using histological features from haematoxylin and eosin staining …

Analysis Of Candida Auris Fungemia At A Single Facility In Kenya, Rodney Adam, Gunturu Revathi, Nancy Okinda, Melanie Fontaine, Jasmit Shah, Elizabeth Kagotho, Mariana Castanheira, Michael A. Pfaller, Daniel Maina

Pathology, East Africa

Objectives: Candida auris emerged as a human pathogen in 2009 and has subsequently been identified around the world as a cause of invasive candidiasis. We did an analysis from a single institution in order to analyze risk factors and outcomes for C. auris candidemia.

Methods: Patients with candidemia were identified by the electronic medical record and reviewed for risk factors and outcome. Candida isolates were identified by Vitek2 as Candida haemulonii, but species determinations for 21 of the isolates using published molecular and proteomic methods identified all as C. auris.

Findings: From September 2010 to December 2016, C. auris accounted …

Diffuse Large B-Cell Lymphoma In Kenya: Myc, Bcl2, And The Cell Of Origin, Jonathan Wawire, Shahin Sayed, Zahir Moloo, Aliyah R. Sohani

Pathology, East Africa

Purpose: Diffuse large B-cell lymphoma (DLBCL) is the most commonly diagnosed non-Hodgkin lymphoma in adults in Kenya. Cell of origin (COO) and double expression of MYC and BCL2 are two important prognostic factors for DLBCL. A small subset (5% to 10%) of DLBCL cases show positivity for CD5 and are associated with poor prognosis, whereas CD30 antigen, seen in up to 10% of cases, may be a useful target for therapy. We sought to determine the prevalence of MYC/BCL2 double expression, COO, and proportion of Epstein-Barr virus positivity among patients with DLBCL diagnosed at a tertiary referral laboratory in Kenya. …

Task Sharing And Shifting To Provide Pathology Diagnostic Services: The Kenya Fine-Needle Aspiration Biopsy Cytology And Bone Marrow Aspiration And Trephine Biopsy Training Program, Shahin Sayed, Andrew Field, Jamilla Rajab, Anderson Mutuiri, Jessie Githanga, Mary Mungania, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Brian Ayara, Erick Chesori, Julia Muthua, Leah Obosy, Thaddeus Massawa, Okoth Obiero, Elizabeth Kagotho, Peter K. Shikuku, Andrew K. Gachii, Eunidah Migide, Donstefano Muninzwa, Sanford M. Dawsey, Lucy Muchiri

Pathology, East Africa

Purpose: Fine-needle aspiration biopsy (FNAB) cytology is a simple, inexpensive, and accurate diagnostic test for benign, infectious, and malignant lesions of the breast, thyroid, lymph nodes, and other organs. Similarly, bone marrow aspiration and trephine (BMAT) biopsy procedures are relatively simple and inexpensive techniques that are important for diagnosing and monitoring many hematologic diseases including leukemias and lymphomas. However, the scarcity of pathologists in Kenya limits patient access to these simple diagnostic tests. We describe a task sharing and shifting program that sought to improve the provision of FNABs and BMAT biopsies in tertiary public hospitals in Kenya.

Methods: Between …

Vitamin D Status In Healthy Black African Adults At A Tertiary Hospital In Nairobi, Kenya: A Cross Sectional Study, Elizabeth Kagotho, Geoffrey Omuse, Nancy Okinda, Peter Ojwang

Pathology, East Africa

Background: Vitamin D has been known since the twentieth Century for its benefits in bone health. Recent observational studies have demonstrated its benefits in infectious diseases such as tuberculosis and non-communicable diseases such as diabetes mellitus, cardiovascular diseases and cancer. This has led to a dramatic increase in testing among adults. The cut-offs for vitamin D deficiency have been debated for decades and the current cut off is derived from a Caucasian population. Studies done among black African adults in Africa are few with vitamin D deficiency ranging from 5 to 91%. A few cut- offs have correlated vitamin D …

Complete Blood Count Reference Intervals From A Healthy Adult Urban Population In Kenya, Geoffrey Omuse, Daniel Maina, Jane Mwangi, Caroline Wambua, Kiran Radia, Alice Kanyua, Elizabeth Kagotho, Mariza Hoffman, Peter Ojwang, Zul Premji, Kiyoshi Ichihara, Rajiv Erasmus

Pathology, East Africa

Background: There are racial, ethnic and geographical differences in complete blood count (CBC) reference intervals (RIs) and therefore it is necessary to establish RIs that are population specific. Several studies have been carried out in Africa to derive CBC RIs but many were not conducted with the rigor recommended for RI studies hence limiting the adoption and generalizability of the results.

Method: By use of a Beckman Coulter ACT 5 DIFF CP analyser, we measured CBC parameters in samples collected from 528 healthy black African volunteers in a largely urban population. The latent abnormal values exclusion (LAVE) method was used …

Breast Cancer Knowledge, Perceptions And Practices In A Rural Community In Coastal Kenya, Shahin Sayed, Anthony Ngugi, Megan R. Mahoney, Jaameeta Kurji, Zohray M. Talib, Sarah B. Macfarlane, Theresa A. Wynn, Mansoor Saleh, Amyn B Lakhani, Esther Nderitu, Felix Agoi, Zul Premji, Jo Anne Zujewski, Zahir Moloo

Pathology, East Africa

Background: Data on breast healthcare knowledge, perceptions and practice among women in rural Kenya is limited. Furthermore, the role of the male head of household in influencing a woman’s breast health seeking behavior is also not known. The aim of this study was to assess the knowledge, perceptions and practice of breast cancer among women, male heads of households, opinion leaders and healthcare providers within a rural community in Kenya. Our secondary objective was to explore the role of male heads of households in influencing a woman’s breast health seeking behavior.

Methods: This was a mixed method cross-sectional study, conducted …

Molecular Characterization Of Multidrug-Resistant Klebsiella Pneumoniaeand Escherichia Coliharbouring Extended Spectrum Beta-Lactamases Andcarbapenemases Genes At A Tertiary Hospital, Kenya, Daniel Maina, Gunturu Revathi, Andrew C. Whitelaw

Pathology, East Africa

Background: Multidrug-resistant (MDR) Gram negative rods are increasingly being reported in sub-Saharan Africa. Molecular investigations play an important role, alongside other measures, in controlling nosocomial infections attributed to these organisms.

This study aimed to determine the common extended spectrum beta-lactamases (ESBL) and carbapenemases genes, and clonal relationship in MDR Klebsiella pneumoniae and Escherichia coli.

Methods: Fifty-four MDR isolates collected at the Aga Khan University hospital, Nairobi in the month of August 2012 formed the study. These were picked after an increase in the number of resistant strains during the said period was experienced.

Results: blaCTXM was present in 41 (74%) …

Comparison Of Equations For Estimating Glomerular Filtration Rate In Screening For Chronic Kidney Disease In Asymptomatic Black Africans: A Cross Sectional Study, Geoffrey Omuse, Daniel Maina, Jane Mwangi, Caroline Wambua, Alice Kiyua, Elizabeth Kagotho, Angela Amayo, Peter Ojwang, Rajiv Erasmus

Pathology, East Africa

Background: Several equations have been developed to estimate glomerular filtration rate (eGFR). The common equations used were derived from populations predominantly comprised of Caucasians with chronic kidney disease (CKD). Some of the equations provide a correction factor for African-Americans due to their relatively increased muscle mass and this has been extrapolated to black Africans. Studies carried out in Africa in patients with CKD suggest that using this correction factor for the black African race may not be appropriate. However, these studies were not carried out in healthy individuals and as such the extrapolation of the findings to an asymptomatic black …

Metabolic Syndrome And Its Predictors In An Urban Population In Kenya: A Cross Sectional Study, Geoffrey Omuse, Daniel Maina, Mariza Hoffman, Jane Mwangi, Caroline Wambua, Elizabeth Kagotho, Angela Amayo, Peter Ojwang, Zul Premji, Kiyoshi Ichihara, Rajiv Erasmus

Pathology, East Africa

Background: The metabolic syndrome (MetS) is a clustering of interrelated risk factors which doubles the risk of cardio-vascular disease (CVD) in 5–10 years and increases the risk of type 2 diabetes 5 fold. The identification of modifiable CVD risk factors and predictors of MetS in an otherwise healthy population is necessary in order to identify individuals who may benefit from early interventions. We sought to determine the prevalence of MetS as defined by the harmonized criteria and its predictors in subjectively healthy black Africans from various urban centres in Kenya.

Method: We used data collected from healthy black Africans in …

Comparison Of Biomarker Based Matrix Assisted Laser Desorption Ionization-Time Of Flight Mass Spectrometry (Maldi-Tof Ms) And Conventional Methods In The Identification Of Clinically Relevant Bacteria And Yeast, Ali Kassim, Valentin Pflüger, Zul Premji, Claudia Daubenberger, Gunturu Revathi

Pathology, East Africa

Background: MALDI-TOF MS is an analytical method that has recently become integral in the identification of microorganisms in clinical laboratories. It relies on databases that majorly employ pattern recognition or fingerprinting. Biomarker based databases have also been developed and there is optimism that these may be superior to pattern recognition based databases. This study compared the performance of ribosomal biomarker based MALDI-TOF MS and conventional methods in the identification of selected bacteria and yeast.

Methods: The study was a cross sectional study identifying clinically relevant bacteria and yeast isolated from varied clinical specimens submitted to a clinical laboratory. The identification …

Evaluation Of The Parasight Platform For Malaria Diagnosis, Yochay Eshel, Arnon Houri-Yafin, Hagai Benkuzari, Natalie Lezmy, Mamta Soni, Malini Charles, Jayanthi Swaminathan, Hilda Solomon, Pavithra Sampathkumar, Zul Premji, Caroline Mbithi, Zaitun Nneka, Simon Onsongo, Daniel Maina, Sarah Levy-Schreier, Caitlin Lee Cohen, Dan Gluck, Joseph Joel Pollak, Seth J. Salpeter

Pathology, East Africa

The World Health Organization estimates that nearly 500 million malaria tests are performed annually. While microscopy and rapid diagnostic tests (RDTs) are the main diagnostic approaches, no single method is inexpensive, rapid, and highly accurate. Two recent studies from our group have demonstrated a prototype computer vision platform that meets those needs. Here we present the results from two clinical studies on the commercially available version of this technology, the Sight Diagnostics Parasight platform, which provides malaria diagnosis, species identification, and parasite quantification. We conducted a multisite trial in Chennai, India (Apollo Hospital [n = 205]), and Nairobi, Kenya …

Urolithiasis Analysis In A Multiethnic Population At A Tertiary Hospital In Nairobi, Kenya, Francis Kiigu, Alfred Hayombe, Daniel Maina

Pathology, East Africa

Background: Urolithiasis is a global problem whose incidence is reported to be on the rise across the world. Previously, urolithiasis was reported as being rare among the indigenous African population but recent data suggest otherwise. This study reviewed the demographic and clinical characteristics of patients with urolithiasis seen at the Aga Khan University hospital Nairobi (AKUHN) as well as the chemical composition of the stones and the modalities of therapy used.

Methods: This was a retrospective study which utilized patients’ clinical and laboratory records from 2013 to 2014. Sixty-seven symptomatic patients with confrmed urolithiasis formed the study. This study aimed …

Reference Intervals For Thyroid Stimulating Hormone And Free Thyroxine Derived From Neonates Undergoing Routine Screening For Congenital Hypothyroidism At A University Teaching Hospital In Nairobi, Kenya: A Cross Sectional Study, Geoffrey Omuse, Ali Kassim, Francis Kiigu, Ra'ana Hussain, Mary Limbe

Pathology, East Africa

Background: In order to accurately interpret neonatal thyroid function tests (TFTs), it is necessary to have population specific reference intervals (RIs) as there is significant variation across different populations possibly due to genetic, environmental or analytical issues. Despite the importance of RIs, globally there are very few publications on RIs for neonatal TFTs primarily due to ethical and technical issues surrounding recruitment of neonates for a prospective study. To the best of our knowledge, this is the first report from Africa on neonatal RIs for TFTs.

Methods: We used hospital based data largely derived from neonates attending the wellness clinic …

High Resolution Melting: A Useful Field-Deployable Method To Measure Dhfr And Dhps Drug Resistance In Both Highly And Lowly Endemic Plasmodium Populations, Yaye Dié Ndiaye, Cyrille K. Diédhiou, Amy K. Bei, Baba Dieye, Aminata Mbaye, Nasserdine Papa Mze, Rachel F. Daniels, Ibrahima M. Ndiaye, Awa B. Déme, Amy Gaye, Mouhamad Sy, Tolla Ndiaye, Aida S. Badiane, Mouhamadou Ndiaye, Zul Premji, Dyann F. Wirth, Souleymane Mboup, Donald Krogstad, Sarah K. Volkman, Ambroise D. Ahouidi, Daouda Ndiaye

Pathology, East Africa

Background: Emergence and spread of drug resistance to every anti-malarial used to date, creates an urgent need for development of sensitive, specifc and feld-deployable molecular tools for detection and surveillance of validated drug resistance markers. Such tools would allow early detection of mutations in resistance loci. The aim of this study was to compare common population signatures and drug resistance marker frequencies between two populations with diferent levels of malaria endemicity and history of anti-malarial drug use: Tanzania and Sénégal. This was accomplished by implementing a high resolution melting assay to study molecular markers of drug resistance as compared to …

The 17th International Congress On Infectious Diseases Workshop On Developing Infection Prevention And Control Resources For Low- And Middle-Income Countries, Sangeeta Sastry, Nadia Masroor, Gonzalo Bearman, Rana Hajjeh, Alison Holmes, Ziad Memish, Britta Lassmann, Didier Pittet, Fiona Macnab, Rachel Kamau, Evelyn Wesangula, Paras Pokharel, Paul Brown, Frances Daily, Fatma Amer, Jaime Torres, Miguel O’Ryan, Gunturu Revathi, Andre Bulabula, Shaheen Mehtar

Pathology, East Africa

Hospital-acquired infections (HAIs) are a major concern to healthcare systems around the world. They are associated with significant morbidity and mortality, in addition to increased hospitalization costs. Recent outbreaks, including those caused by the Middle East respiratory syndrome coronavirus and Ebola virus, have highlighted the importance of infection control. Moreover, HAIs, especially those caused by multidrug-resistant Gram-negative rods, have become a top global priority. Although adequate approaches and guidelines have been in existence for many years and have often proven effective in some countries, the implementation of such approaches in low- and middle-income countries (LMICs) is often restricted due to …

Molecular Characterization Of Staphylococcus Aureus Isolates From Various Healthcare Institutions In Nairobi, Kenya: A Cross Sectional Study, Geoffrey Omuse, Kristien Nel Van Zyl, Kim Hoek, Shima Abdulgader, Samuel Kariuki, Andrew Whitelaw, Gunturu Revathi

Pathology, East Africa

Background: Staphylococcus aureus (S. aureus) has established itself over the years as a major cause of morbidity and mortality both within the community and in healthcare settings. Methicillin resistant S. aureus (MRSA) in particular has been a major cause of nosocomial infections resulting in significant increase in healthcare costs. In Africa, the MRSA prevalence has been shown to vary across different countries. In order to better understand the epidemiology of MRSA in a setting, it is important to define its population structure using molecular tools as different clones have been found to predominate in certain geographical locations.

Methods: We carried …

Spectrum Of Microbial Diseases And Resistance Patterns At A Private Teaching Hospital In Kenya: Implications For Clinical Practice, Daniel Maina, Geoffrey Omuse, Gunturu Revathi, Rodney Adam

Pathology, East Africa

Background: Accurate local prevalence of microbial diseases and microbial resistance data are vital for optimal treatment of patients. However, there are few reports of these data from developing countries, especially from sub-Saharan Africa. The status of Aga Khan University Hospital Nairobi as an internationally accredited hospital and a laboratory with an electronic medical record system has made it possible to analyze local prevalence and antimicrobial susceptibility data and compare it with other published data.

Methods: We have analyzed the spectrum of microbial agents and resistance patterns seen at a 300 bed tertiary private teaching hospital in Kenya using microbial identity …

Safety Of A Single Low-Dose Of Primaquine In Addition To Standard Artemether-Lumefantrine Regimen For Treatment Of Acute Uncomplicated Plasmodium Falciparum Malaria In Tanzania, Richard Mwaiswelo, Billy Ngasala, Irina Jovel, Roland Gosling, Zul Premji, Eugenie Poirot, Bruno Mmbando, Anders Björkman, Andreas Mårtensson

Pathology, East Africa

Background: This study assessed the safety of the new World Health Organization (WHO) recommendation of adding a single low-dose of primaquine (PQ) to standard artemisinin-based combination therapy (ACT), regardless of individual glucose-6-phosphate dehydrogenase (G6PD) status, for treatment of acute uncomplicated Plasmodium falciparum malaria in Tanzania.

Methods: Men and non-pregnant, non-lactating women aged ≥1 year with uncomplicated P. falciparum malaria were enrolled and randomized to either standard artemether-lumefantrine (AL) regimen alone or with a 0.25 mg/kg single-dose of PQ. PQ was administered concomitantly with the first AL dose. All drug doses were supervised. Safety was evaluated between days 0 and 28. …

Mycobacterium Tuberculosis Lineage 4 Comprises Globally Distributed And Geographically Restricted Sublineages, David Stucki, Daniela Brites, Leïla Jeljeli, Mireia Coscolla, Gunturu Revathi

Pathology, East Africa

Generalist and specialist species differ in the breadth of their ecological niches. Little is known about the niche width of obligate human pathogens. Here we analyzed a global collection of Mycobacterium tuberculosis lineage 4 clinical isolates, the most geographically widespread cause of human tuberculosis. We show that lineage 4 comprises globally distributed and geographically restricted sublineages, suggesting a distinction between generalists and specialists. Population genomic analyses showed that, whereas the majority of human T cell epitopes were conserved in all sublineages, the proportion of variable epitopes was higher in generalists. Our data further support a European origin for the most …

Reference Intervals For Thyroid Stimulating Hormone And Free Thyroxine Derived From Neonates Undergoing Routine Screening For Congenital Hypothyroidism At A University Teaching Hospital In Nairobi, Kenya: A Cross Sectional Study, Geoffrey Omuse, Ali Kassim, Francis Kiigu, Syeda Hussain, Mary Limbe

Pathology, East Africa

Background: In order to accurately interpret neonatal thyroid function tests (TFTs), it is necessary to have population specific reference intervals (RIs) as there is significant variation across different populations possibly due to genetic, environmental or analytical issues. Despite the importance of RIs, globally there are very few publications on RIs for neonatal TFTs primarily due to ethical and technical issues surrounding recruitment of neonates for a prospective study. To the best of our knowledge, this is the first report from Africa on neonatal RIs for TFTs.

Methods: We used hospital based data largely derived from neonates attending the wellness clinic …

Adding A Single Low-Dose Of Primaquine (0.25 Mg/Kg) To Artemether-Lumefantrine Did Not Compromise Treatment Outcome Of Uncomplicated Plasmodium Falciparum Malaria In Tanzania: A Randomized, Single-Blinded Clinical Trial, Richard Mwaiswelo, Billy Ngasala, Irina Jovel, Berit Aydin‑Schmidt, Roland Gosling, Zul Premji, Bruno Mmbando, Anders Björkman, Andreas Mårtensson

Pathology, East Africa

Background: The World Health Organization (WHO) recently recommended the addition of a single low-dose of the gametocytocidal drug primaquine (PQ) to artemisinin-based combination therapy (ACT) in low transmission set‑ tings as a component of pre-elimination or elimination programmes. However, it is unclear whether that influences the ACT cure rate. The study assessed treatment outcome of artemether-lumefantrine (AL) plus a single PQ dose (0.25 mg/kg) versus standard AL regimen for treatment of acute uncomplicated Plasmodium falciparum malaria in Tanzania.

Methods: A randomized, single-blinded, clinical trial was conducted in Yombo, Bagamoyo district, Tanzania. Acute uncomplicated P. falciparum malaria patients aged ≥1 year, …

Results From The Survey Of Antibiotic Resistance (Soar) 2011-14 In The Democratic Republic Of Congo, Ivory Coast, Republic Of Senegal And Kenya, A. Kacou-Ndouba, Gunturu Revathi, P. Mwathi, A. Seck, A. Diop, M. J. Kabedi-Bajani, W. Mwiti, M. J. Anguibi-Pokou, I. Morrissey, D. Torumkuney

Pathology, East Africa

Objectives: To assess antibiotic susceptibility of community-acquired respiratory tract isolates from Ivory Coast, Kenya, Democratic Republic of Congo (DRC) and Senegal in 2011–14.

Methods: Bacterial isolates were collected and MICs determined using Etest^® for all antibiotics except erythromycin, for which testing was by disc diffusion. Susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. For macrolide interpretation, CLSI breakpoints were adjusted for incubation in CO₂.

Results: Susceptibility to penicillin (using CLSI oral or EUCAST breakpoints) was low among isolates of Streptococcus pneumoniae from the DRC and Kenya (17.4% and 19%, respectively) but higher among isolates from …

Comparison Of Clinical Laboratory Standards Institute And European Committee On Antimicrobial Susceptibility Testing Guidelines For The Interpretation Of Antibiotic Susceptibility At A University Teaching Hospital In Nairobi, Kenya: A Cross-Sectional Study, Ali Kassim, Geoffrey Omuse, Zul Premji, Gunturu Revathi

Pathology, East Africa

Background: The Clinical Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines are the most popular breakpoint guidelines used in antimicrobial susceptibility testing worldwide. The EUCAST guidelines are freely available to users while CLSI is available for non-members as a package of three documents for US $500 annually. This is prohibitive for clinical microbiology laboratories in resource poor settings. We set out to compare antibiotic susceptibility determined by the two guidelines to determine whether adoption of EUCAST guidelines would significantly affect our susceptibility patterns.

Methods: We reviewed minimum inhibitory concentrations (MIC) of various antibiotics routinely …

Relationship Between Antibody Susceptibility And Lipopolysaccharide O-Antigen Characteristics Of Invasive And Gastrointestinal Nontyphoidal Salmonellae Isolates From Kenya, Robert S. Onsare, Francesca Micoli, Luisa Lanzilao, Renzo Alfini, Chinyere K. Okoro, Anne W. Muigai, Gunturu Revathi, Allan Saul, Samuel Kariuki, Calman A. Maclennan, Simona Rondini

Pathology, East Africa

Background: Nontyphoidal Salmonellae (NTS) cause a large burden of invasive and gastrointestinal disease among young children in sub-Saharan Africa. No vaccine is currently available. Previous reports indicate the importance of the O-antigen of Salmonella lipopolysaccharide for virulence and resistance to antibody-mediated killing. We hypothesised that isolates with more O-antigen have increased resistance to antibody-mediated killing and are more likely to be invasive than gastrointestinal.

Methodology/Principal findings: We studied 192 NTS isolates (114 Typhimurium, 78 Enteritidis) from blood and stools, mostly from paediatric admissions in Kenya 2000-2011. Isolates were tested for susceptibility to antibody-mediated killing, using whole adult serum. O-antigen structural …