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Background: Human infections caused by pathogens transmitted from fish are quite common. The aim of this study was to isolate enteric pathogenic bacteria from fish that might be transmitted to humans after the handling or consumption of such fish. Methodology: One hundred and twenty Nile tilapia fish harvested using various fishing methods were collected from fishermen in five fish landing beaches within Winam Gulf and disinfected externally using 70% ethyl alcohol for 2 minutes then washed three times with autoclaved distilled water. Isolation of Salmonella and Shigella species from fish samples was performed using standard bacteriological procedures. Five milliliters of each fish tissue slurry was microbiologically analyzed for any Enterobacteriaceae. Twelve Nile tilapia collected from three open-air markets were analyzed for Enterobacteriaceae comparison as controls. Identification of Salmonella by using housekeeping genes and species-specific primers was performed. Results: Among 120 Nile tilapia, 63 (52.5%) were infected with Enterobacteriaceae. Out of these, 25 (39.7%) were Shigella spp, 9 (14.3%) Salmonella typhimurium, 7 (11.1%) S. typhi, 4 (6.3%) S. enteritidis, 16 (25.4%) Escherichia coli, 1 (1.6%) Proteus spp. and Enterobacter aerogenes respectively. Ten fish collected from open-air markets yielded E. coli (50%), S. typhimurium (20%), S. paratyphi (10%) and S. typhi (20%). Conclusion: Nile tilapia within Winam Gulf are infected by human enteric pathogens. Shigella spp., Salmonella and E. coli were the most frequently isolated, an indication that the beaches may be contaminated by untreated municipal sewage, runoff, and storm-water. S. typhimurium, S. typhi and S. enteritidis were the most common Salmonella isolates.

Background Diarrhoea is a common cause of mortality and morbidity in children under five years old. In Kenya, it has a 21% case fatality with Enteropathogenic E. coli, Campylobacter jejuni, Shigella spp. and Salmonella spp. accounting for 50–60% of the cases. Sulphonamides, tetracycline, ampicillin and trimethoprim/sulfamethoxazole are typically used in the treatment of diarrhoeal diseases but have become ineffective in the face of emerging antimicrobial resistance. The objective of this study was to evaluate the prevalence and antimicrobial susceptibility of Campylobacter jejuni and Shigella species in children under five years of age presenting with diarrhoea at Kapsabet County Referral Hospital in Kenya. Methods Faecal samples were collected from 139 children admitted with diarrhoea. Each sample was examined macroscopically for colour, texture, and presence of extraneous material. The samples were then cultured for bacterial growth. Observed bacterial growth was isolated and identified by a series of biochemical tests. Resistance patterns were also evaluated using the Kirby – Bauer Disk diffusion method. The chi – square test and Pearson Correlation Coefficient were used to establish statistical significance. Results Approximately 33.1% of the total faecal samples tested were positive for enteric pathogens. Shigella spp. demonstrated resistance to erythromycin (91.7%), doxycyclin (83.3%), ampicillin (82.1%), cotrimoxazole (73.1%), minocycline (66.7%) and cefuroxime (54.2%). Campylobacter jejuni also exhibited resistance to erythromycin (87.5%), doxycyclin (75%), ampicillin (73.7%), cotrimoxazole (73.3%) and minocycline (68.8%). Conclusions The resistance patterns of Shigella spp. and Campylobacter jejuni reported in this study necessitates the need for a comprehensive multiregional investigation to evaluate the geographical prevalence and antimicrobial resistance distributions of these microorganisms. These findings also support the need for the discovery and development of effective therapeutic alternatives. Trial registration Retrospectively registered. Certificate No. 00762

Background. Nutritional status is an important determinant of HIV outcomes. Objective. To assess the nutrient intake and nutrient status of HIV seropositive patients attending an AIDS outpatient clinic, to improve the nutritional management of HIV-infected patients. Design. Prospective cohort study. Setting. Comprehensive care clinic in Chulaimbo Sub-District Hospital, Kenya. Subjects. 497 HIV sero-positive adults attending the clinic. Main Outcome Measures. Evaluation of nutrient intake using 24-hour recall, food frequency checklist, and nutrient status using biochemical assessment indicators (haemoglobin, creatinine, serum glutamate pyruvate (SGPT) and mean corpuscular volume (MCV)). Results. Among the 497 patients recruited (M : F sex ratio: 1.4, mean age: 39 years ± 10.5 y), Generally there was inadequate nutrient intake reported among the HIV patients, except iron (10.49 ± 3.49 mg). All the biochemical assessment indicators were within normal range except for haemoglobin 11.2 g/dL (11.4 ± 2.60 male and 11.2 ± 4.25 female). Conclusions. Given its high frequency, malnutrition should be prevented, detected, monitored, and treated from the early stages of HIV infection among patients attending AIDS clinics in order to improve survival and quality of life.

Background: Salmonella spp. are recognized as some of the most common causes of enteritis worldwide. This study aimed to identify clinically isolated S. Typhimurium in western Kenya and to assess antimicrobial resistance profiles and strain inter-relatedness. Methods: The study was performed in rural Maseno, Nyanza province in Kenya, between February 2004 and June 2005. Sixty-three patients with diarrhoea and fever were recruited. S. Typhimurium isolates were confirmed using serotyping, biochemical testing, and 16S rRNA sequencing. Susceptibility to 20 antimicrobials was determined and specific resistance genes were identified by polymerase chain reaction (PCR). Strain diversity was further analyzed using pulsed-field gel electrophoresis (PFGE), fluorescence amplified fragment length polymorphism (fAFLP), and multi-locus-variable-number-tandem regions (MLVNTR). Results: Twenty S. Typhimurium strains were isolated in the course of the study and their identity was confirmed by 16S rRNA gene sequencing. All 20 S. Typhimurium strains were resistant to ampicillin, streptomycin and sulfamethoxazole; ciprofloxacin resistance and phage DT104 were not detected. PFGE, plasmid profiling, and analysis of selected VNTR loci revealed further heterogeneity among the strains in the study. Conclusion: S. Typhimurium was commonly isolated from patients with diarrhoea and fever in Maseno. Considerable phenotypic and genotypic diversity was observed among isolates, suggesting that strains belonging to multiple lineages are responsible for disease in the study region. Multiple resistance was common and mediated by a variety of resistance genes but not by phage DT104.

Background: Brucellosis is a zoonotic disease that continues to infect many people worldwide. Though its mortality rate is low, long convalescent periods associated with brucellosis translate into reduced socio-economic capacity of the people affected. Human brucellosis is mostly transmitted from animals. In Kenya, the prevalence of the disease has increased recently, along with the increased hawking of unpasteurized milk. The extent of the risk such raw milk poses to human health with respect to brucellosis is unknown. This study investigates the possibility of brucellosis being transmitted through unprocessed milk sold by hawkers in Eldoret municipality. Methodology: In this cross-sectional study, 130 samples of unpasteurized pooled milk from hawkers and 14 pasteurized milk samples were collected from shops in selected estates using cluster and simple random sampling techniques. All samples were subjected to the Brucella Milk Ring Test (MRT) for screening. A milk consumption questionnaire was administered to households in the selected estates to establish their milk sources and consumption patterns. Data analysis involved comparing computed percentages of different variables. Results: A high proportion of households (77.5%) consume unpasteurized milk from hawkers. However, no antibody to Brucella was detected in any of the milk samples collected. Conclusion: We find no evidence that hawked milk in Eldoret is responsible for transmitting brucellosis to consumers. More research in the potential transmission of brucellosis through milk consumption is recommended.

Background: The threat to human health posed by antibiotic resistance is of growing concern. Many commensals and pathogenic organisms have developed resistance to well established and newer antibiotics. This is a cross-sectional study within two hospital settings to determine in vitro antibiotic susceptibilities of Salmonella species isolated in blood, cerebral spinal fluid, pus and stool collected from in-and out-patients. The inclusion criteria was non restrictive to in-and out-patient but preference to severe diarrhea cases with negligible changes to previous treatment regimen was observed. The study was carried out from February 2004 -June 2005. Fifty-three diarrhea patients within the hospital who were chosen by convenient sampling and consented to participate in the study were considered. Methodology: Either blood or pus was collected using vacutainer tubes and syringe, swabs respectively, and cerebral spinal fluid by lumbar puncture from patients who had fever (temp ≥ 38°C) and diarrhea. Stool samples were also colle cted and all specimens analyzed for the presence of Salmonella by routine microbiological procedures. The isolates were subjected to antibiotic susceptibility testing using disc diffusion technique. Results: In St. Elizabeth Mukumu Mission Hospital, Salmonella enterica serovar Typhi was most common (56.6%, n=33), followed by S. typhimurium (34%, n=18), while in Maseno Mission Hospital only S. typhimurium was isolated. Whereas S. typhi was more commonly isolated in male adults and female children (P = 0.9), S. typhimurium was more common in female and male children (P=0.1). All the isolates were sensitive to ciprofloxacin. However, S. typhi was resistant to streptomycin, ampicillin, chloramphenical and cotrimoxazole; S. typhimurium to tetracycline, sulfamethoxazole, cotrimoxazole, ampicillin, chloramphenical and streptomycin. Conclusions: S. typhi displayed a high resistance pattern to most antibiotic screened than S. typhimurium.