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J Infect Dev Ctries

Estimated burden of fungal infections in Kenya.

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Estimated burden of fungal infections in Kenya.

J Infect Dev Ctries. 2016;10(8):777-784

Authors: Guto JA, Bii CC, Denning DW

Abstract
INTRODUCTION: Kenya is a developing country with a high rate of tuberculosis (TB) and a moderate HIV infection burden. No estimate of the burden of fungal diseases in Kenya is published.
METHODOLOGY: We used specific populations at risk and fungal infection frequencies from the literature to estimate national incidence or prevalence of serious fungal infections. Used sources were: 2010 WHO TB statistics, Kenya Acquired Immunodeficiency Syndrome (AIDS) Epidemic Update 2012, Kenya Facts and figures 2012, Kenya Demographic and Health Survey 2008-2009.
RESULTS: Of Kenya’s population of ~40 million, 43% are under 15 years old and approximately 594,660 Kenyan women get >4 episodes Candida vulvovaginitis annually (2,988/100,000). The HIV/AIDS population at risk of opportunistic infections (OI) is 480,000 and the OI estimates include 306,000 patients with oral thrush (768/100,000), 114,000 with oesophageal candidiasis (286/100,000), 11,900 with cryptococcal meningitis (29/100,000) and 17,000 patients with Pneumocystis pneumonia (42/100,000). Chronic pulmonary aspergillosis following TB has a prevalence of 10,848 cases (32/100,000). The adult asthma prevalence is 3.1% and assuming 2.5% have allergic bronchopulmonary aspergillosis then 17,696 (44/100,000) are affected.  Invasive aspergillosis, candidaemia and Candida peritonitis are probably uncommon. Tinea capitis infects 9.6% of children in Kenya, while fungal keratitis and otomycoses are difficult to estimate.
CONCLUSION: At any one time, about 7% of the Kenyan population suffers from a significant fungal infection, with recurrent vaginitis and tinea capitis accounting for 82% of the infections. These estimates require further epidemiological studies for validation.

PMID: 27580321 [PubMed – as supplied by publisher]

Itraconazole-resistant Candida auris with phospholipase, proteinase and hemolysin activity from a case of vulvovaginitis.

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Itraconazole-resistant Candida auris with phospholipase, proteinase and hemolysin activity from a case of vulvovaginitis.

J Infect Dev Ctries. 2015 Apr;9(4):435-7

Authors: Kumar D, Banerjee T, Pratap CB, Tilak R

Abstract
Since the emergence of pathogenic non-albicans Candida species, a number of new isolates have been added to the list. One such unusual species is Candida auris (C. auris), recently isolated and studied in few reports. In this study, a case of vulvovaginitis caused by Candida auris incidentally identified by molecular methods using internal transcribed spacer polymerase chain reaction (ITS PCR) is described. Antifungal susceptibility testing revealed the isolate to be resistant to itraconazole (MIC ≥ 2 µg/ml) and expressed important virulence factors including phospholipase, proteinase and hemolysin activity. The patient was successfully treated with oral fluconazole and did not have any invasive fungemia. Very few cases of this emerging pathogen have been reported. However, its isolation from clinical specimens reveals the significance of non-albicans candida species over C. albicans and the diversity of Candida spp causing infections.

PMID: 25881537 [PubMed – indexed for MEDLINE]

Antibiotics in surgical wards: use or misuse? A newly industrialized country’s perspective.

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Antibiotics in surgical wards: use or misuse? A newly industrialized country’s perspective.

J Infect Dev Ctries. 2015;9(11):1264-71

Authors: Lim MK, Lai PS, Ponnampalavanar SS, Syed Omar SF, Taib NA, Yusof MY, Italiano CM, Kong DC, Kamarulzaman A

Abstract
INTRODUCTION: Studies exploring the appropriateness of therapeutic antibiotic use among surgical patients are limited, particularly in developing countries. Therefore, the aim of our study was to determine the appropriateness of antibiotics prescribed in a surgical setting in Malaysia.
METHODOLOGY: A prospective observational study was conducted in two surgical wards at a tertiary hospital in Malaysia from November 2012-July 2013. Data was collected using a case report form. The appropriateness of antibiotic therapy was based on compliance with either the Malaysian National Antibiotic Guidelines 2008 or International Clinical Practice Guidelines and determined by an expert panel (consisting of two infectious disease consultants and a pharmacist).
RESULTS: Over the study period, a total of 593 antibiotic courses were prescribed for 129 patients (4.6±3.4 antibiotics/patient). Only 34 (26.4%) patients received appropriate antibiotic therapy, whilst 95 (73.6%) patients received at least one course of inappropriate antibiotic therapy. The prevalence of inappropriate antibiotic use was 214 (66.3%) and 55 (42.0%) for prophylactic and therapeutic purposes, respectively. The most common causes of inappropriate prophylactic antibiotics were inappropriate timing 20 (36.4%) and inappropriate duration of prophylaxis 19 (34.5%). In cases of inappropriate timing, 9 (45%) were administered too late while 6 (30%) were too early. In contrast, inappropriate choice of antibiotics (42.1%) and inappropriate indication (40.7%) were the most common reasons encountered for inappropriate therapeutic antibiotics.
CONCLUSION: Our study suggests considerable inappropriate use of both prophylactic and therapeutic antibiotics in the surgical wards; highlighting an urgent need for antibiotic stewardship initiatives in this setting.

PMID: 26623636 [PubMed – in process]

Vancomycin susceptibility trends of methicillin-resistant Staphylococcus aureus isolated from burn wounds: a time for action.

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Vancomycin susceptibility trends of methicillin-resistant Staphylococcus aureus isolated from burn wounds: a time for action.

J Infect Dev Ctries. 2015;9(11):1284-1288

Authors: Zorgani AA, Elahmer O, Abaid A, Elaref A, Elamri S, Aghila E, Tubbal A

Abstract
INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) with reduced susceptibility to vancomycin poses a threat for patients in burn units throughout the world. This study aimed to investigate the reduced susceptibility to vancomycin of MRSA isolated from wounds of patients admitted to the Burns and Plastic Surgery Centre in Tripoli, Libya.
METHODOLOGY: All isolates were initially identified by chromagen medium then confirmed by PCR. The minimum inhibition concentration (MIC) was determined by E-test glycopeptide resistance detection (GRD).
RESULTS: During the study, 210 isolates were obtained from 560 patients representing 132 (62.9%) and 78 (37.1%) of total samples received during years 2009 and 2010, respectively. MIC levels for vancomycin ranged from 0.5 to 2 µg/ml during the study, 13% of isolates displayed MIC of 1.5 µg/ml and 9% of the isolates displayed 2 µg/ml. Although MRSA isolates decreased dramatically during 2010 (37.1%) compared to 2009 (62.9%), overall, there was a significant increase in the proportion of MRSA isolates exhibiting higher vancomycin MICs during 2010 compared to 2009 (P = 0.0155). There was a significant increase of MICs at 1 µg/ml during 2010 compared with 2009 (P = 0.36). No vancomycin intermediate or resistant strains were found.
CONCLUSION: There was a significant increase in the proportion of MRSA isolates exhibiting higher vancomycin MICs. We recommend that MRSA isolates should be monitored. Furthermore, implementation of infection control measures is urgently needed to prevent the spread of MRSA.

PMID: 26623639 [PubMed – as supplied by publisher]