Objective-Several fastidious bacteria have been associated with bacterial vaginosis (BV), but their role in lactobacilli recolonization failure is unknown. We studied the effect of seven BVassociated bacterial species and two Lactobacillus species on vaginal colonization with L. crispatus CTV-05 (LACTIN-V).Methods-Twenty four women with BV were given a 5-day course of metronidazole vaginal gel and then randomized 3:1 to receive either LACTIN-V or placebo applied vaginally once daily for 5 initial consecutive days, followed by a weekly application over 2 weeks. Vaginal swabs for L. crispatus CTV-05 culture and 9-bacterium specific 16S rRNA gene quantitative PCR assays were analyzed on several study visits for the 18 women receiving LACTIN-V.Results-Vaginal colonization with CTV-05 was achieved in 61% of the participants receiving LACTIN-V at either the day 10 or the 28 visit and 44% at day 28. Participants not colonized with CTV-05 had generally higher median concentrations of BV-associated bacteria compared to those who colonized. Between enrollment and day 28, the median concentration of Gardnerella vaginalis minimally reduced from 10 4.5 to 10 4.3 16S rRNA gene copies per swab in women who colonized with CTV-05 but increased from 10 5.7 to 10 7.3 in those who failed to colonize (p=0.19). Similarly, the median concentration of Atopobium spp. reduced from 10 2.7 16S rRNA gene copies per swab to below limit of detection in women who colonized with CTV-05 but increased from 10 2.7 to 10 6.6 in those who failed to colonize (p=0.04). The presence of endogenous L. crispatus at enrollment was found to be significantly associated with a reduced odds of colonization with CTV-05 on day 28 (p=0.003) and vaginal intercourse during the study significantly impaired successful CTV-05 colonization (p=0.018).Corresponding Author Benjamin M. Ngugi, Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464-00202 Nairobi, Kenya, Tel: +254-20-2720794; +254-725-808838, Fax: +254-20-2720030, bm_ngugi@yahoo.com. NIH Public Access

These study findings suggest that albendazole improved efficacy of DEC and mass administration of a combination of the two drugs would therefore enhance the interruption of transmission of W. bancrofti in endemic areas. This information has important implications for the ongoing Global Program for Elimination of Lymphatic Filariasis.

IntroductionGlobally Cryptosporidium and Giardia species are the most common non-bacterial causes of diarrhoea in children and HIV infected individuals, yet data on their role in paediatric diarrhoea in Kenya remains scant. This study investigated the occurrence of Cryptosporidium species, genotypes and subtypes in children, both hospitalized and living in an informal settlement in Nairobi.MethodsThis was a prospective cross-sectional study in which faecal specimen positive for Cryptosporidium spp. by microscopy from HIV infected and uninfected children aged five years and below presenting with diarrhoea at selected outpatient clinics in Mukuru informal settlements, or admitted to the paediatric ward at the Mbagathi District Hospital were characterized. The analysis was done by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) of the 18srRNA gene for species identification and PCR-sequencing of the 60 kDa glycoprotein (GP60) gene for subtyping.Results C. hominis was the most common species of Cryptosporidium identified in125/151(82.8%) of the children. Other species identified were C. parvum 18/151(11.9%), while C. felis and C. meleagridis were identified in 4 and 2 children, respectively. Wide genetic variation was observed within C. hominis, with identification of 5 subtype families; Ia, Ib, Id, Ie and If and 21 subtypes. Only subtype family IIc was identified within C. parvum. There was no association between species and HIV status or patient type.Conclusion C. hominis is the most common species associated with diarrhoea in the study population. There was high genetic variability in the C. hominis isolates with 22 different subtypes identified, whereas genetic diversity was low within C. parvum with only one subtype family IIc identified.

The prevalence of iron-deficiency anemia (IDA) is high in infants in Sub-Saharan Africa. Exclusive breastfeeding of infants to 6 months of age is recommended by the World Health Organization, but breast milk is low in iron. Some studies suggest exclusive breastfeeding, although beneficial for the infant, may increase risk for IDA in resource-limited settings. The objective of this study was to determine if duration of exclusive breastfeeding is associated with anemia and iron deficiency in rural Kenyan infants. This was a cross-sectional study of 6-10-month-old infants (n = 134) in southern coastal Kenya. Anthropometrics, hemoglobin (Hb), plasma ferritin (PF), soluble transferrin receptor (sTfR), and C-reactive protein were measured. Body iron stores were calculated from the sTfR/PF ratio. Socioeconomic factors, duration of exclusive breastfeeding, nature of complementary diet, and demographic characteristics were determined using a questionnaire. Mean ± SD age of the infants was 7.7 ± 0.8 months. Prevalence of anemia, ID, and IDA were 74.6%, 82.1%, and 64.9%, respectively. Months of exclusive breastfeeding correlated positively with Hb (r = 0.187; p < .05) and negatively with sTfR (r = -0.246; p < .05). sTfR concentrations were lower in infants exclusively breastfed at least 6 months compared with those exclusively breastfed for less than 6 months (7.6 (6.3, 9) vs. 8.9 (6.7, 13.4); p < .05). Controlling for gender, birth weight, and inflammation, months spent exclusively breastfeeding was a significant negative predictor of sTfR and a positive predictor of Hb (p < .05). The IDA prevalence in rural Kenyan infants is high, and greater duration of exclusive breastfeeding predicts better iron status and higher Hb in this age group.

Dogs living in a domestic–wildlife interface can serve as reservoirs and sentinels of parasites shared among humans, domestic animals and wildlife. In Kenya, the epidemiology of intestinal parasites of dogs and their role as reservoirs of zoonoses is poorly understood, especially in domestic–wildlife interfaces. This study aimed to determine the occurrence of intestinal helminths in domestic dogs in the Oloisukut Conservancy. One hundred dog faecal samples were collected per rectum and examined microscopically following zinc chloride flotation and formal-ether concentration techniques. Genotyping of helminths was achieved by nested polymerase chain reaction of NADH dehydrogenase subunit 1, cytochrome oxidase 1 and partial sequencing. Nine genera were detected by microscopy in 65 (65%) dog faecal samples from 54/76 (71.05%) households. The most frequent helminths were hookworm (39%), Spirometra spp. (17%), taeniids (13%), Toxocara spp. (10%), Trichuris spp. (10%), Spirocerca lupi (5%), Physaloptera spp. (2%), Dipylidium caninum (1%) and Strongyloides spp. (1%). Ancylostoma caninum was the only hookworm species detected in dogs, while Taenia serialis and Taenia madoquae were detected in four and one faecal samples, respectively. This study reports for the first time the molecular detection of the cestodes Spirometra theileri, D. caninum and Mesocestoides sp. in dogs in Kenya. The presence of zoonotic helminths in dogs indicates that the residents of this conservancy are exposed to public health risks. The helminths reported here confirm the interaction of domestic dogs with wildlife. An integrated control programme involving the medical, veterinary and wildlife conservation professionals is needed to avert transmission of infectious diseases to humans, domestic animals and wildlife.

Entamoeba histolytica is the only pathogenic species of the Entamoeba genus and is morphologically identical to E. dispar / E. moshkovskii ( Entamoeba complex) hence cannot be microscopically differentiated. The other Entamoeba spp. found in humans ( E. hartmanni, E. polecki, and E. coli ) can be differentiated morphologically from this Entamoeba complex. However, some of their morphologic features overlap making differential diagnosis difficult. This study aimed at determining the occurrence of Entamoeba spp. in patients seeking treatment for diarrhea and/or abdominal discomfort at two clinics in Mukuru informal settlement in Nairobi, Kenya. Faecal samples were collected from 895 patients, examined microscopically following direct wet smear and formal-ether concentration methods. Entamoeba spp. positive faecal samples were subjected to DNA extraction and species-specific nested polymerase chain reaction of the 18S ribosomal RNA (rRNA). By microscopy, Entamoeba spp. cysts or trophozoites were detected in 114/895 (12.7%, 95% Confidence Interval (CI) 10.6–15.1) faecal samples. By nested PCR, the prevalence was: E. histolytica (7.5%, 95% CI 5.9–9.4, 67/895) and E. dispar (8.2%, 95% CI 6.5–10.2, 73/895). Among the Entamoeba spp. complex positive samples, nested PCR detected E. coli and E. hartmanni DNA in 63/114 (55.3%) and 37/114 (32.5%), samples respectively. Among the E. histolytica / E. dispar PCR negative samples (32.5%), 21 (18.4%) contained cysts of either E. coli (19) or E. hartmanni (2) by nested PCR. Entamoeba spp. infections were most common among participants aged 21–30 years; however it was not significant ( P = 0.7). Entamoeba spp. infections showed an inverse relationship with diarrhea being most common among participants without diarrhea ( P = 0.0). The difference was significant for E. histolytica ( P = 0.0) but not significant for E. dispar ( P = 0.1). Only E. dispar infections were significantly associated with sex ( P = 0.0). This study highlights the need for differentiation of E. histolytica from other Entamoeba spp. by molecular tools for better management of amoebiasis.

Background: Type-2 diabetes mellitus is recognized as a key non-communicable disease affecting over 425 million world-wide, with only half of them currently diagnosed. The most crucial risk factor for mortality associated with type-2 diabetes is poor adherence to the prescribed medication.Methods: A cohort study design was used to study 98 type 2 diabetes patients in Kiambu County. Consecutive sampling method was used. The collection of data utilized a pre-designed and piloted structured questionnaire. Quantitative data analysis was conducted using SPSS version 26.0 and correlation between the total count of the remaining diabetic medication and the blood sugar after one month follow-up was assessed. Univariate logistic regression was conducted in assessing the association between each of the predictor variables and the two main outcome variables (adherence to medication and glycemic control). A multiple logistic regression model was constructed for each of the two outcome variables.Results: 31 (31.6%) of the study subjects were between 60-69 years, 70 (71.4%) were married and 66 (67.3%) were female. In addition, 37 (37.8%) had diabetes for more than 8 years, 70.6% had hypertension and 83.7% were prescribed oral hypoglycaemic agents as initial treatment. Majority of the respondents constituting 80.7% had high adherence to prescribed diabetes medication regimen, knowledge on diabetes treatment (p=0.009) and detecting low blood sugar levels through signs and symptoms and manage (p=0.001) had significantly association with adherence to antidiabetic.Conclusions: Diabetic patients who have knowledge on diabetes and its management, those who stop alcohol and cigarette smoking and those who understand hypertension are more likely to adhere to diabetic treatment.