Prevalence of methicillin resistance in Staphylococcus pseudintermedius isolates from dogs with skin and ear infections in South Africa

Staphylococcus pseudintermedius (SP) is an important opportunistic pathogen, frequently associated with pyoderma and otitis in dogs. The emergence and rapid expansion of methicillin-resistant Staphylococcus pseudintermedius (MRSP) is problematic due to multidrug resistance and reduced treatment options. The aim of this study was to determine i) the prevalence of MRSP in dogs with pyoderma or otitis externa, ii) the antimicrobial resistance patterns of MRSP from South African isolates, and iii) the risk factors for MRSP-associated pyoderma or otitis externa in dogs in South Africa (RSA). Sixty-eight presumptive clinical SP isolates (collected from 65 dogs) from five geographically dispersed laboratories in RSA were collected over 2 years. Possible MRSP isolates were flagged when resistance to oxacillin was observed. Thereafter, all isolates were confirmed as SP by polymerase chain reaction (PCR) and further genotyped for the mecA gene. Fifty-seven of 68 isolates were confirmed to be SP (83.8%), while 49/57 (85.9%) carried mecA. Our findings showed that preliminary phenotypic methods supplemented by genotypic methods increased the accuracy of correctly identifying SP. All isolates were resistant to at least one antimicrobial drug. There was a high incidence of amoxicillin (70.1%) and enrofloxacin (65%) resistance. Important risk factors for mecA positive carriage were previous hospital admission, pruritus, and previous antibacterial failure. This study demonstrates a high prevalence of mecA positive carriage (85.9% of samples) in MRSP pyoderma and otitis in dogs in RSA. There is an urgent need for better laboratory diagnosis of MRSP and surveillance of dogs presenting with pyoderma and otitis in South Africa.

The Relationship between S. aureus and Branched-Chain Amino Acids Content in Composite Cow Milk

The early diagnosis of mastitis is an essential factor for the prompt detection of the animal for further actions. In fact, if not culled, infected cows must be segregated from the milking herd and milked last, or milked with separate milking units. Besides microbiological analysis, the somatic cell count (SCC) commonly used as predictor of intramammary infection, frequently lead to a misclassification of milk samples. To overcome these limitations, more specific biomarkers are continuously evaluated. The total amino acid content increases significantly in mastitic milk compared to normal milk. S. aureus requires branched-chain amino acids (BCAAs-isoleucine, leucine, and valine) for protein synthesis, branched-chain fatty acids synthesis, and environmental adaptation by responding to their availability via transcriptional regulators. The increase of BCAAs in composite milk has been postulated to be linked to mammary infection by S. aureus. The aim of this work is to demonstrate, by a direct ion-pairing reversed-phase method, based on the use of the evaporative light-scattering detector (IP-RP-HPLC-ELSD), applied to 65 composite cow milk samples, a correlation between the concentration of isoleucine and leucine, and S. aureus load. The correlation coefficient, r, was found to be 0.102 for SCC (p = 0.096), 0.622 for isoleucine (p < 0.0001), 0.586 for leucine (p < 0.0001), 0.013 for valine (p = 0.381), and 0.07 for tyrosine (p = 0.034), standing for a positive correlation between S. aureus and isoleucine and leucine concentration. The link between the content of BCAAs, isoleucine and leucine, and udder infection by S. aureus demonstrated with our study has an important clinical value for the rapid diagnosis of S. aureus mastitis in cows.

Relationship between dietary patterns and stunting in preschool children: a cohort analysis from Kwale, Kenya

OBJECTIVES

Stunting is a significant cause of poor cognitive performance and lower school achievement. Stunting is observed among pre-school children in several areas in Africa; however, not all children are affected, and children with and without stunting are seen in the same communities. Therefore, this study aimed to identify nutritional and other factors that prevent stunting that may exist in local communities.

STUDY DESIGN

This is a prospective cohort study.

METHODS

Data were extracted from the Health and Demographic Surveillance System conducted in Kwale County, Kenya. The cohort consisted of all households with children less than five years old, within a radius of 2.2 km from a local health centre. A dietary pattern (DP) survey with a semi-quantitative food frequency questionnaire was conducted on caretakers of children who were voluntary participated from the cohort between June 2012 and August 2012. Using cluster analysis, the children were assigned to a DP group. Logistic regression analysis was applied to calculate the adjusted odds ratios (aORs) of DPs for stunting controlling for other factors.

RESULTS

In total, 402 children were included in the analysis. By cluster analysis, three DPs were identified: protein-rich DP; traditional DP; and traditional DP complemented by breastfeeding. The aOR of a child becoming stunted from a normal height during the study period among children who received a traditional DP compared with those who had a protein-rich DP was 2.78 (95% confidence interval [CI]: 1.02-7.55). However, the aOR for children who were already stunted at the start of the study and had a traditional DP was 1.49 (95% CI: 0.82-2.72). Increased aORs of stunting were observed among children aged over 12 months compared with children aged 6-11 months, and the effects of DPs were modified by age in months from 12 to 35 months; however, the effects were near the null value for children over 36 months of age, although these were not statistically significant.

CONCLUSIONS

We found that the traditional DP showed a higher risk for stunting compared with the protein-rich DP, and the most vulnerable age range for stunting was between 12 and 35 months. Interventions to prevent stunting should focus on providing 12- to 35-month-old children with locally available, protein-rich foods.

Do clients receiving Home based testing and counselling (HBTC) utilize the HIV prevention messages delivered? A study among residents in an urban informal settlement in Kenya who previously received HBTC

BACKGROUND

Home based HIV testing and counseling (HBTC) increases access to services and is associated with high testing uptake. Alongside testing, individuals are offered HIV prevention messages with an aim of helping them reduce HIV high risk sexual behaviors. This study explored the level of provision and subsequent utilization of HIV prevention messages and associated change in behavior among individuals who had received HBTC previously in an informal settlement.

METHODS

In a mixed method cross sectional study, we interviewed 1257 individuals and conducted 6 focus group discussions (FGD). Multiple correspondence analysis (MCA) was used to construct provision of prevention messages and behavior change indices using STATA 3.0. Pearson's chi-square statistics was used to test for bivariate association between the outcomes and logistic regression analysis was carried out with the behavior change index as the outcome of interest and the predictors considered significant (p<0.1). Thematic content analysis for qualitative data was done using Atlas 3.0.

RESULTS

Out of the 1257participants, 1078 (85.8%) had ever tested for HIV, with 74.2% having tested in the Kibera HBTC program. Nearly all (97.4%) rated HBTC experience as either excellent (62.4%) or good (37%) and would recommend it to a friend. Provision of prevention messages was high among HBTC clients compared to clients from other testing sites; partner reduction counselling (64% versus 52%) and faithfulness (78.3% versus 67%); p=0.001. Self-reported behavior change after HBTC was generally low with condom use at 10.7% and men more likely to practice safer sex (p = 0.002). Trust of the sexual partners and fear of suspicion were the main reasons given for not using condoms. Clients testing HIV positive after previous negative result were 3.4%. The focus group discussions reported multiple sexual partnerships among both HIV negative and positive residents alike.

CONCLUSION

Although prevention messages delivered during HBTC are accepted and appreciated in this community, their utilization is low in both HIV negative and positive individuals. Innovative strategies for change of normative beliefs about sexual behavior are urgently needed.

Evolution under different storage conditions of anomalous blue coloration of Mozzarella cheese intentionally contaminated with a pigment-producing strain of Pseudomonas fluorescens

Several widespread occurrences of anomalous blue coloration of Mozzarella cheese have been recorded in the United States and some European countries. Official laboratory analysis and health authorities have linked the occurrences to contamination of the processing water with strains of Pseudomonas fluorescens, although several experts questioned how to unequivocally link the blue color to the presence of the microorganism. To establish a method to determine whether a given Pseudomonas spp. strain is responsible for the defect and study the evolution of the coloration under different storage conditions, we developed an in vitro system for the evaluation of blue coloration of Mozzarella cheese intentionally contaminated with strains of P. fluorescens. The purpose of the system was to determine whether P.fluorescens strains, isolated from Mozzarella cheese with anomalous blue coloration, were able to reproduce the blue coloration under controlled experimental conditions. Thirty-six trials of experimental inoculation of Mozzarella cheese in different preservation liquids were conducted using various suspensions of P.fluorescens (P. fluorescens ATCC 13525, P.fluorescens CFBP 3150, and P. fluorescens 349 field strain isolated from blue-colored Mozzarella cheese) at different concentrations and incubated at different temperatures. Growth curves of all tested P.fluorescens strains demonstrated that after 3 d of incubation the concentration was generally >10(6) cfu/g of Mozzarella cheese incubated in either tryptic soy broth (control) or conditioning brine. Prolonged incubation for 5 d at either 20 °C or 8 °C led to concentrations up to 10(9) cfu/g of Mozzarella cheese incubated in tryptic soy broth and up to 10(8) cfu/g of Mozzarella cheese incubated in preservation liquid. All Mozzarella cheeses inoculated with the field strain of P. fluorescens, except those opened 1h after packaging and stored at 8 °C, showed the characteristic anomalous blue coloration, which appeared from 1 to 72 h after opening the packaging, and was proportional to colony count, duration of storage, and storage temperature. With the proposed system, which enabled a larger number of samples to be analyzed under controlled experimental conditions and a large amount of data to be generated in a short time, we described precisely how and under which conditions the presence of P. fluorescens in Mozzarella cheese is responsible for the anomalous blue coloration. The system will help producers intercept contaminated batches and help consumers avoid the conditions under which the defect can appear.

ROLES OF TRADITIONAL BIRTH ATTENDANTS AND PERCEPTIONS ON THE POLICY DISCOURAGING HOME DELIVERY IN COASTAL KENYA

OBJECTIVES

To describe the roles of Traditional Birth Attendants (TBAs), to determine the perceptions of TBAs and Skilled Birth Attendants (SBAs) towards the policy discouraging home delivery by TBAs and to establish the working relationship between TBAs and SBAs in Kwale, Kenya.

DESIGN

Community based cross-sectional study.

SETTING

Mwaluphamba, Kinango and Golini locations of Kwale County, Kenya.

SUBJECTS

Fifty eight participants were involved in the study. Interviews were conducted with 22 TBAs and 8 SBAs as well as 3 FGDs with 28 TBAs were carried out in July 2012.

MAIN OUTCOME MEASURES

Roles of TBAs, policy awareness and support as well as the working relationship between TBAs and SBAs.

RESULTS

Before delivery, the main role of TBAs was checking position of the baby in the womb (86%) while during delivery, the main role was stomach massage (64%). However, majority (95%) of the TBAs did not provide any after delivery. All SBAs and 59% of TBAs were aware of the policy while 88% SBAs and 36% of TBAs supported it. The working relationship between TBAs and SBAs mainly involved the referral of women to health facilities (HFs). Sometimes, TBAs accompanied women to the HF offering emotional support until after delivery.

CONCLUSION

TBAs in Kwale have a big role to play especially during pregnancy and delivery periods. Awareness and support of the policy as well as the collaboration between SBAs and TBAs should be enhanced in Kwale.

FACTORS ASSOCIATED WITH UPTAKE OF SKILLED ATTENDANTS' SERVICES DURING CHILD DELIVERY IN GARISSA TOWN, KENYA

OBJECTIVE

To identify the factors that are associated with uptake of skilled delivery services during child delivery among women of reproductive age in Garissa town.

DESIGN

Cross sectional study.

SETTING

Garissa town.

SUBJECT

Three hundred and thirty four women aged 15-49 years who had had at least one delivery in their lifetime were asked about the type of delivery services they had during their last child delivery.

RESULTS

The study found that 47% of the last deliveries women were attended by skilled persons and the rest of the deliveries were provided by TBAs. The predictors of skilled delivery uptake in this study were found to be; having knowledge on skilled delivery service providers (AOR = 17.2; 95% CI: 1.05-281.12; p = 0.046), child deliveries numbering one to three (AOR = 116.95; 95% CI: 26.68-512.64; p = 0.001) and four to six (AOR = 16.75; 95% CI: 4.44-62.87; p = 0.001), presence of previous delivery complication (AOR = 11.71; 95% CI: 3.96-34.60; p = 0.001), disapproval of TBA services (AOR = 27.19; 95% CI: 6.67-110.76; p = 0.001), lack of preference for gender of skilled delivery service provider (AOR = 6.51; 95% CI: 1.08-39.37; p = 0.041), and positive view on service related factors such as time to nearest facility (AOR = 3.91; 95% CI: 1.24-12.34; p = 0.020), hygiene (AOR = 5.03; 95% CI: 1.49-17.05; p = 0.009) and operation time of health facility (AOR = 4.67; 95% CI: 1.59-13.76; p = 0.005).

CONCLUSSION

The findings show that cultural and maternal factors as well as quality of services at facility level play major role in determining uptake of skilled services among women in Garissa as compared to social demographic and economic factors.

Methods for genotyping verotoxin-producing Escherichia coli

Verotoxin-producing Escherichia coli (VTEC) is annually incriminated in more than 100,000 cases of enteric foodborne human disease and in losses amounting to $US 2.5 billion every year. A number of genotyping methods have been developed to track VTEC infections and determine diversity and evolutionary relationships among these microorganisms. These methods have facilitated monitoring and surveillance of foodborne VTEC outbreaks and early identification of outbreaks or clusters of outbreaks. Pulsed-field gel electrophoresis (PFGE) has been used extensively to track and differentiate VTEC because of its high discriminatory power, reproducibility and ease of standardization. Multiple-locus variable-number tandem-repeats analysis (MLVA) and microarrays are the latest genotyping methods that have been applied to discriminate VTEC. MLVA, a simpler and less expensive method, is proving to have a discriminatory power comparable to that of PFGE. Microarrays are successfully being applied to differentiate VTEC and make inferences on genome diversification. Novel methods that are being evaluated for subtyping VTEC include the detection of single nucleotide polymorphisms and optical mapping. This review discusses the principles, applications, advantages and disadvantages of genotyping methods that have been used to differentiate VTEC strains. These methods have been mainly used to differentiate strains of O157:H7 VTEC and to a lesser extent non-O157 VTEC.

Detection of tet(M) gene from raw milk by rapid DNA extraction followed by a two-step PCR with nested primers

The likelihood that milk and milk products may act as a vehicle for antibiotic-resistant bacterial genes has become a concern to the food industry and a public health issue, and the demand for rapid tests has increased. The purity of DNA extracted from food samples is a key issue in the sensitivity and usefulness of biological analyses, such as PCR for pathogens and nonpathogens. A rapid, phenol-chloroform free method based on a modification of a sodium iodide DNA extraction, followed by a two-step PCR was developed for direct detection of the tet(M) gene in milk samples within a single working day. This study compares the proposed method with a traditional phenol solvent extraction method and with a commercial kit (QIAamp DNA blood mini kit, Qiagen). The three DNA extraction methods were used to ensure access to the tet(M) gene from 1 ml of raw milk, inoculated with a strain of Enterococcus faecalis, which carries the tet(M) gene. The proposed method, followed by a two-step PCR with nested primers specific for the tet(M) gene, was able to reach a detection limit below 10 CFU/ml in less than 4 h, including the two amplification cycles, thus outperforming in sensitivity and rapidity both the traditional and the commercial method.

Enterotoxin production by Staphylococcus aureus isolated from mastitic cows

Staphylococcus aureus is an important cause of mastitis in cows. The ability of S. aureus strains to produce one or more enterotoxins in milk and dairy products is linked to staphylococcal food poisoning. To determine whether staphylococci causing bovine mastitis could cause human foodborne intoxication, the production of staphylococcal enterotoxins A through D (SEA, SEB, SEC, and SED) by 160 S. aureus isolates was evaluated with the use of a reverse passive latex agglutination enterotoxin kit. All S. aureus strains were isolated over a 9-month period from 2,343 routine submissions of a composite quarter collection of individual mastitic cows at 18 dairy farms in the San Joaquin Valley in California. Prior to enterotoxin detection, isolates were grown by a method that enhances the in vitro synthesis of enterotoxin. Twenty-two of 160 S. aureus isolates produced enterotoxin. Seven produced SEC, 12 produced SED, and 3 produced both SEC and SED. None of the isolates produced SEA or SEB.

Microbial quality of ostrich carcasses produced at an export-approved South African abattoir

The aim of this study was to evaluate the microbial quality of ostrich carcasses produced in a South African export-approved ostrich abattoir. Ninety surface samples were collected from 30 ostrich carcasses at three processing points in the abattoir: after skinning, after evisceration, and after chilling. Samples were evaluated for aerobic plate counts, for levels of Pseudomonas spp., Enterobacteriaceae, and Staphylococcus aureus, and for the presence of Escherichia coli. Surface counts (means +/- standard deviations) at postskinning, postevisceration, and postchilling processing points were, respectively, 4.32 +/- 0.62, 4.21 +/- 0.63, and 4.57 +/- 0.48 log CFU/cm2 for total aerobes; 2.82 +/- 1.65, 2.86 +/- 1.53, and 3.75 +/- 0.94 log CFU/ cm2 for Pseudomonas spp.; 2.89 +/- 0.78, 2.90 +/- 0.53, and 2.38 +/- 0.67 log CFU/cm2 for S. aureus; and 2.55 +/- 1.53, 2.78 +/- 1.31, and 2.73 +/- 1.46 log CFU/cm2 for Enterobacteriaceae. Statistically significant differences were detected between the counts for the postskinning and postchilling processing points and between the counts for the postevisceration and postchilling processing points for total aerobes, Pseudomonas spp., and S. aureus. Of practical significance was the increase in Pseudomonas spp. counts on samples collected after chilling. Seventeen of 90 samples (18.8%) tested positive for E. coli. Counts for E. coli-positive samples ranged from 1.0 to 3.79 log CFU/cm2, with a mean count of 2.15 +/- 0.94 log CFU/cm2. The majority of the samples testing positive for E. coli were collected after evisceration.

Prevention of bacterial diarrhea by pasteurization of drinking water in Kenya

Diarrheal disease is one of the major causes of morbidity and mortality in developing countries. Drinking water is a primary transmission route of infectious diarrheagenic bacteria in a rural area of Kenya (Microbiol. Immunol. 41: 773-778, 1997). We tried to prevent diarrhea at villages with approximately 1,500 households in Kenya by pasteurizing drinking water. A durable simple thermoindicator which changes color at 70 C was used as an indicator of pasteurization. The number of households in which drinking water was coliform bacteria-free increased from 10.7% to 43.1% after adoption of a pasteurization practice. Consequently, the incidence of severe diarrhea among people drinking pasteurized water was significantly lower than in people taking raw water (odds ratio=0.55, P=0.0016). The reduction ratio of the incidence after pasteurization was nearly equivalent with that after the adoption of a boiling method. Employment of women leaders as fieldworkers and demonstration of bacterial colony disappearance on agar plates by pasteurization also affected reduction of the diarrheal incidence.

Pattern of Schistosoma mansoni infection after intervention in Mwea irrigation scheme in Kenya

A longitudinal study of Schistosoma mansoni reinfection rate was carried out in an endemic area of Kenya, after intervention. Intervention measures applied involved chemotherapy, community mobilization to effect change in water contact habits and faecal disposal. This paper focuses on S. mansoni reinfection pattern over a two-year period. The age group 5-19 years showed an increasing trend of reinfection as compared to the 30-59 years age group. More than 50% in the 5-19 year age group had been reinfected by twelve months of follow-up. They were also responsible of 91% of all the egg-load and 83% of all the infections at the end of the study period. Since majority of the 5-19 year age group comprises school children, there is an urgent need of including issues related to schistosomiasis in the school curriculum especially in the endemic areas.

Perception of a schistosomiasis control project in rural Kenya by the beneficiaries

A schistosomiasis control project was implemented in Mwea Rice Irrigation Scheme in Central Kenya between late 1983 and December 1988 by Kenya Medical Research Institute scientists in collaboration with the National Irrigation Board. The aim of the project was to control schistosomiasis through provision of alternative water sources, bath and laundry units, latrines, chemotherapy and health education. The community participated fully. Five years later in December 1988, 203 household heads were interviewed on their perception of the control project in terms of purpose, project ownership and management, benefits, continuity and their knowledge of schistosomiasis transmission cycle. 61% of the respondents were females and 39% males. 92% of them said that the purpose for the project was to treat, control and prevent bilharzia from spreading, and to promote good health. Slightly over 50% said that the project belonged to them but that they would have liked to be more involved in its management. 74% said that they are able to save time because the facilities are now nearer to them; whilst 79% felt that they were saving money because they did not have to buy drugs since they felt healthier. 99% said that they thought that bilharzia has been controlled, and 82% said that their children looked healthier. 95% said that they could see the project surviving for a long time period suggesting that it was self sustaining and they were willing to start a maintenance of facilities fund. Overall, the community appreciated the social, economic and health benefits derived from the control project.

Involvement of a community in schistosomiasis control: a Kenyan experience

This paper illustrates how community participation was achieved in a study that was carried out between 1983-1988 whose general objective was to reduce the transmission of schistosomiasis in a rice irrigation scheme in Kenya. A community of 2,219 people was mobilized through health education, to effect changes in behaviour regarding water contact, water use and faecal disposal. Health education, alternative water sources, latrines and mass chemotherapy with praziquantel were the schistosomiasis control strategies utilized in this study. By the end of 2 years, the canals were cleared of their thick vegetation, water, sanitation, bathing and washing facilities were constructed, water contact with infective waters was reduced, faecal contamination of water was reduced, the people's knowledge on schistosomiasis increased and the rate and intensity of schistosomiasis infection was reduced. The study demonstrated that it is possible to fully involve the community in disease control efforts.