We read with interest two recent reports of Comamonas kerstersii-related infections in the abdomen (1) and bloodstream (2). We wish to add our own experience with C. kerstersii-related abdominal infections.Case 1. A 10-year-old boy presented with a 1-day history of abdominal pain. Examination revealed peritonitis in the right iliac fossa. On admission, his white blood cell count was 10.3 ϫ10 9 / liter and his C-reactive protein level was 228 mg/liter. A diagnosis of appendicitis was made, and an open appendectomy revealed a perforated appendix. Microscopic examination of peritoneal pus showed small numbers of Gram-negative bacilli that were plated onto Columbia blood agar (Oxoid), chocolate agar (Oxoid), and fastidious anaerobic agar with blood (Oxoid). After 48 h of incubation at 36°C in ambient air, colonies on the blood agar plate were identified by matrix-assisted laser desorption ionizationtime of flight (MALDI-TOF) mass spectrometry (Bruker) as C. kerstersii and a fine growth on the anaerobic plate was identified by MALDI-TOF as Streptococcus constellatus. These were the only organisms isolated. Postoperatively, the patient received piperacillin-tazobactam for 5 days and was discharged on amoxicillinclavulanic acid and ciprofloxacin, making a full recovery.Case 2. A 9-year-old boy presented with a 3-day history of right-sided constant abdominal pain associated with pyrexia. Examination revealed a tender right iliac fossa with localized peritonitis. On admission, his white blood cell count was measured at 13.6 ϫ10 9 /liter and his C-reactive protein level was 65 mg/liter. He developed septic shock and underwent emergency surgery, during which a perforated appendix was resected. Microscopic analysis of intraoperative peritoneal pus and an operative swab of the perforated appendix showed numerous pus cells but no organisms. After 48 h of incubation (as detailed above), the peritoneal fluid grew S. constellatus, Bacteroides fragilis, and C. kerstersii, as identified by MALDI-TOF, and the appendix swab revealed a pure growth of C. kerstersii. The patient received 3 days of intravenous amoxicillin-clavulanic acid, gentamicin, and metronidazole and was discharged on oral amoxicillin-clavulanic acid. He made a full recovery.C. kerstersii, which has undergone extensive reclassification (3, 4), was isolated from our patients as part of a polymicrobial growth from peritoneal fluid. MALDI-TOF appeared to be a reliable tool for identifying these organisms. In case 1, C. kerstersii was identified with a score of 2.275, followed by Comamonas testosteroni (1.664) and Comamonas aquatica (1.579), and in case two, C. kerstersii was identified with a score of 2.294, followed by C. aquatica (1.585), Brenneria nigrifluens (1.299), and C. testosteroni (1.222). The antibiotic sensitivities of the isolates obtained are shown in Table 1. In addition, disc diffusion testing of the isolate from case 2 for amoxicillin-clavulanic acid showed a large zone of Ͼ25 mm, suggesting sensitivity, and the use of amoxicillin-clavulanic acid resu...
BackgroundThe latest outbreak of Ebola in West Africa overwhelmed the affected countries, with the impact on health extending far beyond Ebola–related deaths that have exceeded 11 000. The need to promptly mobilise resources to control emerging infections is widely recognized. Yet, data on research funding for emerging infections remains inadequately documented.MethodsWe defined research investment as all funding flows for Ebola and/or Marburg virus from 1997 to April 2015 whose primary purpose was to advance knowledge and new technologies to prevent or cure disease. We sourced data directly from funding organizations and estimated the investment in 2015 US dollars (US$).ResultsFunding for Ebola and Marburg virus research in 1997 to 2015 amounted to US$ 1.035 billion, including US$ 435.4 million (42.0%) awarded in 2014 and 2015. Public sources of funding invested US$ 758.8 million (73.1%), philanthropic sources US$ 65.1 million (6.3%), and joint public/private/philanthropic ventures accounted for US$ 213.8 million (20.6%). Prior to the Ebola outbreak in 2014, pre–clinical research dominated research with US$ 443.6 million (73.9%) investment. After the outbreak, however, investment for new product development increased 942.7–fold and that for clinical trials rose 23.5–fold. Investment in new tools to control Ebola and Marburg virus amounted to US$ 399.1 million, with 61.3% awarded for vaccine research, 29.2% for novel therapeutics research such as antivirals and convalescent blood products, and 9.5% for diagnostics research. Research funding and bibliometric output were moderately associated (Spearman’s ρ = 0.5232, P = 0.0259), however number of Ebola cases in previous outbreaks and research funding (ρ = 0.1706, P = 0.4985) and Ebola cases in previous outbreaks and research output (ρ = 0.3020, P = 0.0616) were poorly correlated.ConclusionSignificant public and philanthropic funds have been invested in Ebola and Marburg virus research in 2014 and 2015, following the outbreak in West Africa. Long term, strategic vision and leadership are needed to invest in infections with pandemic potential early, including innovative financing measures and open access investment data to promote the development of new therapies and technologies.
International financing of infectious disease research by UK funding organisations follows former colonial ties. Funding institutions should review their funding policies to ensure that they also assist low- and middle-income countries without colonial ties to address their disease burden. A global investment surveillance system is needed to map and monitor funding for international research and guide the allocation of scarce resources to reduce the global disease burden.
The Democratic Republic of the Congo (DRC) is tremendously wealthy. Abundant in gold, diamonds, tantalum, tin, copper, zinc and cobalt, the natural resources in Africa's third largest country are not equally benefiting the people. The DRC should sustainably be making use of their natural resources to develop the country, whose health, education and transport systems all suffer to this day from the effects of conflict. Instead, the DRC is divided with rebels, corrupt governments and foreign investors all fighting in one way or another for control over the country's wealth. The following article focuses on the emergence of rape as a strategy of war in the DRC.
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