BackgroundIn Sub-Saharan Africa, infectious diarrhea is a major cause of morbidity and mortality. A case-control study was conducted to identify the etiology of diarrhea and to describe its main epidemiologic risk factors among hospitalized children under five years old in Bangui, Central African Republic.MethodsAll consecutive children under five years old hospitalized for diarrhea in the Pediatric Complex of Bangui for whom a parent’s written consent was provided were included. Controls matched by age, sex and neighborhood of residence of each case were included. For both cases and controls, demographic, socio-economic and anthropometric data were recorded. Stool samples were collected to identify enteropathogens at enrollment. Clinical examination data and blood samples were collected only for cases.ResultsA total of 333 cases and 333 controls was recruited between December 2011 and November 2013. The mean age of cases was 12.9 months, and 56% were male. The mean delay between the onset of first symptoms and hospital admission was 3.7 days. Blood was detected in 5% of stool samples from cases. Cases were significantly more severely or moderately malnourished than controls. One of the sought-for pathogens was identified in 78% and 40% of cases and controls, respectively. Most attributable cases of hospitalized diarrhea were due to rotavirus, with an attributable fraction of 39%. Four other pathogens were associated with hospitalized diarrhea: Shigella/EIEC, Cryptosporidium parvum/hominis, astrovirus and norovirus with attributable fraction of 9%, 10%, 7% and 7% respectively. Giardia intestinalis was found in more controls than cases, with a protective fraction of 6%.ConclusionsRotavirus, norovirus, astrovirus, Shigella/EIEC, Cryptosporidium parvum/hominis were found to be positively associated with severe diarrhea: while Giardia intestinalis was found negatively associated. Most attributable episodes of severe diarrhea were associated with rotavirus, highlighting the urgent need to introduce the rotavirus vaccine within the CAR’s Expanded Program on Immunization. The development of new medicines, vaccines and rapid diagnostic tests that can be conducted at the bedside should be high priority for low-resource countries.

The aim of this study was to estimate the prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) in faeces of healthy children aged 0-59 months in Bangui (Central African Republic). Stool samples of 134 children, recruited for a matched case-control study, were cultured on a commercial ESBL-selective chromogenic medium (CHROMagar ESBL, France). The phenotypic resistance patterns of isolated strains were investigated, as well as the genetic basis for antibiotic resistance. The factors associated with increased risk for ESBL-E carriage were also studied. The prevalence of ESBL-E carriage was 59% (79/134), one of the highest reported worldwide. The only factor found to be associated with carriage was living in a highest-income family (p=0.03). In all, 83 ESBL-E were recovered as simultaneous carriage of two strains was detected in four children. bla was found in all strains except two, frequently associated with qnr (54/81, 66%) and aac(6')-Ib-cr (35/81, 43%) genes. Escherichia coli, the most commonly recovered species (51/83, 61%), was assigned mainly to the pandemic B2-O25b-ST131 group (39/51, 76%). Resistance transfer, which was studied in 20 randomly selected ESBL-E strains, was successful in 13 (13/20, 65%) isolates. In eight of these isolates (8/13, 62%), bla genes were found in incompatibility group FIb conjugative plasmids. We found one of the highest prevalence rates of faecal carriage of ESBL-E reported worldwide, highlighting the need to improve control of the distribution of antibiotics in limited-resource countries.

BackgroundAntibiotic combination therapy for Helicobacter pylori eradication must be adapted to local resistance patterns, but the epidemiology of H. pylori resistance to antibiotics is poorly documented in Africa. The aim was to determine the antibiotic resistance rates, as well as the associated molecular mechanisms, of strains isolated in Dakar, Senegal.MethodsOne hundred and eight H. pylori strains were isolated between 2007 and 2009 from 108 patients presenting with upper abdominal pain to the Gastroenterology Department of Le Dantec Hospital. Antimicrobial susceptibility testing was performed for amoxicillin, clarithromycin, metronidazole, levofloxacin and tetracyclin using the E-test method. Mutations in the 23S rRNA gene of clarithromycin-resistant strains and in gyrA and gyrB of levofloxacin-resistant strains were investigated.ResultsIsolates were characterized by no resistance to amoxicillin (0%), tetracycline (0%), and very low rate of resistance to clarithromycin (1%), but a high rate of resistance to metronidazole (85%). The clarithromycin-resistant strain displayed the A2143G mutation. A worrying rate of levofloxacin resistance was detected (15%). N87I and D91N were the most common mutations in the quinolone-resistance-determining region of gyrA.ConclusionsThe first-line empirical regimen for H. pylori eradication in Senegal should include clarithromycin. Increasing rates of fluoroquinolone resistance detected should discourage the use of levofloxacin-containing regimens without prior antimicrobial susceptibility testing.

is a major cause of severe diarrhea in children less than the age of 5 years in sub-Saharan Africa. The aim of this study was to describe the (sub-)serotype distribution and antimicrobial susceptibility of serogroups from Centrafrican patients with diarrhea between 2002 and 2013. We collected 443 isolates in total. The most common serogroups were ( = 243, 54.9%), followed by ( = 90, 20.3%) and ( = 72, 16.3%). The high diversity of (sub-)serotypes of and may impede the development of an efficient vaccine. Rates of resistance were high for ampicillin, chloramphenicol, tetracycline, and cotrimoxazole but low for many other antimicrobials, confirming recommendations for the use of third-generation cephalosporins (only one organism resistant) and fluoroquinolones (no resistance). However, the detection of one extended-spectrum beta-lactamase-producing organism highlights the need for continued monitoring of antimicrobial drug susceptibility.

Background Current risk assessment models to predict the risk of recurrent venous thromboembolism (VTE) in an individual patient (i.e Vienna Pedicitive Model, DASH score) include clinical and biochemical parameters and have showed discrimination values ranging from 0.64 to 0.68. Genetic variants associated to thrombophilia have showed to play a relevant role in predicting primary VTE. Combination of those genetic variables together with clinical parameters may improve the predictive capacity of current models for predicting recurrent VTE. Aim To analyze the predictive capacity of a new clinic-genetic score for predicting recurrence of VTE, Thrombo inCode-Recurrent (TiC-Reccurent). Methods A population of 55 patients with a first VTE and none or one or more recurrent VTE (21 males, 34 females; 47.8±14.7 years old) and 39 controls with only the first VTE event (13 males, 26 females; 40.2±13.2 years old) and the same follow-up was used. A regression model was constructed including clinical variants (age, gender, diabetes status, pregnancy status, contraceptive hormonal therapy, smoker status and family history of VTE) and genetic variants (F5 rs6025/rs118203906/rs118203905, F2 rs1799963, F12 rs1801020, F13 rs5985, SERPINC1 rs121909548, and SERPINA10rs2232698 plus the A1 blood group (rs8176719, rs7853989, rs8176743, rs8176750). The predictive capacity was assessed by calculating the c-statistic (AUC-ROC); sensitivity, specificity Positive and Negative Likehoood ratios and odds ratio of a positive test result. Informed consent was obtained and the study was approved by the Institution Ethics Committee. This study complies with the guiding principles for experimental procedures found in the Declaration of Helsinkiof the World Medical Association. Results In an univariate analysis, none of the clinic or genetic variables showed a significant difference between the patient with or without recurrences. TiC-Recurrent score showed a predictive capacity for recurrent VTE measures as AUC-ROC: 0.738, p<0,0001. For TiC-Recurrent the clinical sensitivity was 81.82 and the specificity was 33.33. The predictive capacity measures as LR+, LR- were 1.23 and 0.55, respectively. The odds ratio for TiC-recurrent was 2.7. Conclusions TIC-Recurrent score showed a good predictive capacity to identify subject at high risk of suffering a recurrence of VTE. Although a direct comparison to current scores for predicting the risk for a recurrence of VTE was not possible in the present study if the observed predictive capability for TiC-recurrent is confirmed it will improve the capacity of current scores. Our study suggests that the use of a clinical-genetic algorithm could be an aid in the treatment of patient with a first VTE and contribute to the prevention of VTE recurrences. Disclosures No relevant conflicts of interest to declare.