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Bacterial vaginosis (BV) is extremely common among the African population and is associated with the transmission and acquisition of human immunodeficiency virus (HIV) infection. The objective of this study was to determine the prevalence and characteristics of BV among HIV-infected and -uninfected women in rural Eastern Cape province of South Africa. A descriptive cross-sectional study was conducted between September 2017 and March 2018 on women aged 18 years and above (n = 100), attending Nelson Mandela Academic Hospital and Ngangelizwe Community Health Centre with signs and symptoms suggestive of vaginal infection. High vaginal swabs were collected, and BV was diagnosed using Nugent’s score. The prevalence rate of BV was 70% irrespective of HIV status. Of the 61 HIV-infected patients, 49 (80.3%) and 12 (19.7%) were BV positive and BV negative, respectively; whilst of the 39 HIV-uninfected women, 21 (53.8%) and 18 (46.2%) were BV positive and BV negative, respectively (OR = 3.5; CI: 1.4–8.5; p = 0.005 ). Women aged above 35 years were highly likely to develop BV ( p = 0.049 ). The presence of Mobiluncus species (>25 per high microscopic field) was significantly associated with BV among HIV-infected patients ( p = 0.030 ). A recent history of antibiotic use (≤3 months) was significantly associated with BV among HIV-negative patients ( p = 0.044 ). This study shows that BV is more prevalent among HIV-positive women than their HIV-negative counterparts, and its occurrence is higher among those aged above 35 years. The predominance of Mobiluncus species in the vagina microbiota of HIV-infected women might play a significant role in the development of BV. These findings suggest that the treatment of BV could restore normal flora and reduce susceptibility to and transmission of HIV.

BackgroundCombination antiretroviral drugs (cARVs) prolong patients’ lives but are unfortunately thought to increase complications related to metabolic disorders including type-2 Diabetes Mellitus (DM). We sought to confirm the association of cARVs with type-2 DM and ascertain the extent of this association in a rural South African setting.MethodsA case-control study of 177 (33.33%) cases with HIV/AIDS and type-2 DM were selected and compared with 354 (66.67%) non-DM HIV/AIDS unmatched controls from a rural district of South Africa’s third most populous province (Eastern Cape). Cases were identified from community health centres using the district health information system, and controls were identified using simple random sampling from the same health facilities. Odds Ratios (OR), together with 95% confidence intervals, were calculated for all the univariable and multivariable logistic analyses.ResultsThis study found that cARVs significantly increased the occurrence of type-2 DM among HIV patients. Patients on protease inhibitors (PIs) were at least 21 times significantly (pConclusionThis study has been able to establish the association between cARVs and type-2 DM. It therefore proposes consideration of the usage of AZT, D4T, lopivavir and ritonavir for the treatment of HIV. The study further proposes more prospective research to test these findings further.

Background To effectively reduce vertical HIV transmission requires a reduction of HIV prevalence and incidence among pregnant women and a full understanding of its epidemiology. The study aimed to determine the prevalence of HIV among women attending antenatal care and further determine spousal support during antenatal care attendance in rural areas in Eastern Cape province, South Africa. Methods A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted using an interviewer-administered questionnaire which collected information on socio-demographic characteristics and medical history. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (95%CI) is used for precision of estimates; p≤0.05 for statistical significance. Results A total of 343 participants were included in the final analysis. The antenatal HIV prevalence was 38.2% (95%CI: 33.2–43.9). For 75% of the women, the HIV diagnosis was made 141 days before the date of the interview (median=77 days, interquartile range=42–141 days). Participants between the age of 30 to 39 years were 50% more likely to be HIV positive compared to those who were between the age of 20 to 29, these differences were statistically significant (PR=1.5; p-value=0.001). Furthermore, self-employed women were 30% less likely to be HIV positive when compared to unemployed participants, this was also statistically significant (PR=0.7; p-value Conclusion Despite a 100% antenatal HIV testing rate, the antenatal HIV prevalence remains high in this population, coupled with no spousal attendance in antenatal care. It is important to move beyond awareness about the HIV status to actionable strategies of reducing the HIV incident cases. It is therefore important to remain vigilant and monitor mother-to-child transmission that could be associated with this increased prevalence.

Background Pseudomonas aeruginosa (P. aeruginosa) are Gram-negative bacilli that are ubiquitous in nature particularly plentiful in soils and in aquatic milieu because they thrive well in humid or wet environments. It has extensive metabolic versatility, ability to thrive well and colonize diverse ecological habitats such as soil, rhizosphere, wastewaters that, enhances its potential threat to public health. Abattoirs, aquatic ecosystem including generated wastewaters are latent sources of pathogenic bacteria, serve as reservoirs and contribute to the spread of antibiotic resistant genes. Several studies have focused on clinical environment while scarce data exist from non-clinical environments, which sometimes are hotspots of antibiotic resistance. Thus, the present investigation aimed to identify antibiotic resistant gene of P. aeruginosa from non-clinical sources in Mthatha, Eastern Cape and evaluate its public health implications. Results Fifty-five (55) Pseudomonas species and other organisms recovered from effluent and surface water samples included P. aeruginosa (65.4%), P. fluorescens (27.3%), Burkholderia gladioli (5.5%) and Burkholderia cepacia (1.8%). The P. aeruginosa isolates showed high resistance to aztreonam (86.1%), ceftazidime (63.9%), piperacillin (58.3%) and cefepime (55.6%); with moderate resistance displayed to imipenem (50%), piperacillin/tazobactam (47.2%), meropenem (41.7%) and levofloxacin (30.6%). Twenty out of thirty-six (36) P. aeruginosa displayed multidrug resistance profiles and were classified as multidrug resistant (MDR) (55.6%). Most of the bacterial isolates exhibited a high Multiple Antibiotic Resistance (MAR) Index of > 0.2 ranging from 0.08–0.69 with a mean MAR Index of 0.38. PCR analysis of fifteen (15) P. aeruginosa isolates detected 14 (93.3%) harbored blaSHV, 6 (40%) harbored blaTEM with the least occurring ESBL as blaCTX−M at 3 (20%). Conclusions Results of the current study indicating resistance of environmental P. aeruginosa isolates to front-line clinically relevant antipseudomonal drugs is concerning and poses risk to the environment and receiving water bodies. Given the public health relevance, the results of this study highlight the importance and urgent need of monitoring multidrug-resistant pathogens in effluent environments. These non-clinical environments are potential reservoirs of resistance genes that would further serve as avenues for the dissemination of multidrug resistant bacteria in the community.

Background The study sought to determine factors associated with prolonged smear positivity in multidrug-resistant tuberculosis (MDR-TB) patients following an appropriate management.Methods Newly diagnosed patients [(100 MDR-TB and 100 drug-susceptible TB (DS-TB)] were enrolled between June 2017 and May 2018. Clinical and radiological findings were recorded. Sputum samples were collected for Xpert® MTB/RIF and line probe assays (LiPA). Microscopic tests, including smear grading, were performed at baseline, 4, 8 and 12 weeks post anti-TB therapy. Kaplan-Meier and Cox regression analyses were performed using SPSS v23 with ρ set at ≤ 0.05.Results Of the 200 patients (median age of 34.8 years), 114 (57%) were HIV positive. After 12 weeks of treatment, there was a significant microscopy conversion rate among DS-TB patients [43/45 (95.6%)] as compared to MDR-TB patients [54/69 (78.3%)] (ρ = 0.009), all co-infected with HIV. Similarly, among HIV negative patients, a significant microscopy conversion rate was noted among DS-TB patients [48/55(69.6%)] as compared to MDR-TB patients [21/31(30.4%)] (ρ = 0.03). Time to microscopy conversion was 4.58 ± 2.97 weeks and 5.69 ± 3.25 weeks for HIV positive patients aged ≥35 years and

With the emergence of Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) strains of Mycobacterium tuberculosis, Tuberculosis (TB) has become an even greater threat in South Africa (SA). The study sought to investigate the resistance pattern of anti-TB drugs in M. tuberculosis as well as to determine the associated risk factors and outcomes for MDR-TB and XDR-TB. A descriptive study was conducted in 2 sub-districts of Eastern Cape province. Laboratory testing on sputum samples was done using genotypic and phenotypic methods. Data related to risk factors and outcomes were collected. SPSS v.22 was used for statistical analyses. 224 patients were enrolled (33.9% HIV negative and 66.1% HIV positive). Of 224 TB isolates obtained, 196 (87.5%) were MDR-TB (including 23 rifampicin mono-resistant isolates), 2 (0.9%) were isoniazid mono-resistant and 26 (11.6%) were Pre-XDR and XDR-TB. Of 196 MDR-TB patients, 143 (72.9%) had a favourable outcome post anti-TB therapy as compared to 17(65.4%) XDR-TB patients out of 26; but this difference was not statistically significant (OR = 1.5; CI: 0.6 – 3.4; ρ = 0.27). Whilst 118 (68.6%) out of 172 MDR-TB cases were newly diagnosed, previous exposure to anti-TB therapy was found to be a significant risk factor for developing XDR-TB (OR = 2.5; CI = 1.1 – 5.9; ρ = 0.023).Despite that 34 (26.2%) out of 130 new drug-resistant (DR)-TB patients completed their therapy, only 17 (13.1%) were declared cured as compared to 23 (33.8%) cured patients among the previously treated group (ρ

Introduction : The metabolic syndrome (MetS) is common in human immune deficiency virus (HIV)-infected individuals receiving highly active antiretroviral therapy (HAART). Immune deficiencies caused by HIV give rise to numerous opportunistic gastrointestinal pathogens such as Helicobacter pylori, the commonest cause of chronic gastritis. The study sought to determine the relationship between H pylori infection and the MetS among HIV-infected clinic attendees. Methods : This cross-sectional study was carried out in a specialised heart clinic in Kinshasa, DR Congo. Between January 2004 and December 2008, 116 HIV-infected patients (61 with MetS and 55 without MetS) who underwent upper gastrointestinal endoscopy for dyspeptic symptoms were included in the study following an informed consent. Univariate associations were determined by odds ratios (OR), while multivariate logistic regression analysis was used to identify factors associated with the MetS. Results :H pylori infection (OR = 13.5, 95% CI: 10.3-17.6; p < 0.0001) and peripheral obesity (median hip circumference ≥ 97 cm) (OR = 4.7, 95% CI: 1.2-18.8; p = 0.029) were identified as MetS-related factors in HIV-infected patients. Higher rates of the MetS were associated with increased incidence of HIV-related immunocompromise using World Health Organisation (WHO) staging criteria. There was a univariate significant difference in the prevalence of the MetS between antiretroviral therapy (ART)-naive patients and patients treated by means of a first-line HAART regimen of stavudine (d4T), lamivudine (3TC) and nevirapine (NVP). However, this difference was not significant in multivariate logistic analysis. Conclusion :H pylori infection was significantly associated with the MetS in HIV-infected patients.

The objective of this study was to identify important biomarker differences between absence of HM and expected morphopathologic types of HM. A retrospective analysis study of adult patients aged ≥ 20 years was managed by cytologic aspects such as normal myelogram vs. HM types between 2009 and 2015. Out of 105 patients, 63 (60%) experienced incident HM while 42, 14, 18, 10, 10, 6, and 5 patients had normal myelogram, multiple myeloma (MM), acute myeloid leukaemia (AML), myelodysplastic syndromes (MDS), chronic myeloid leukaemia (CML), acute myeloid leukaemia (CLL) and acute lymphoid leukaemia (ALL), respectively. In Discriminant Analysis (DA), only levels of transfusion, Hb, and WCC discriminated significantly (Wilks lambda =0.159; P < 0.0001) the study groups through Function 1 [Eigen value (EV) = 2.591; cumulative variance (CV) = 78, 7% and Canonical correlation (CC) = 0.849], Function 2 (EV = 0.619; CV = 97.5%; CC = 0.618), and Function 3 (EV = 0.081; CV = 100%; CC = 0.274). The highest Mahalanobis distance (Min D Squared = 0.162) was observed between CML and MDS. For early diagnosis, precise medicine, and good practice in hematologic oncology, DA separated CML, MDS, MM, AML, CLL, and ALL from normal myelogram in Congolese patients.

Introduction: The study sought to ascertain the prevalence of the aetiological agents of genital discharge and genital ulcer diseases in Maputo, Mozambique. Methodology: Consecutive consenting patients presenting to the Centro de Saude do Porto in Maputo between March and April 2005 with genital discharge syndrome and/or genital ulcer diseases were recruited. Specimens were collected for the identification of STI pathogens. Results: Of 346 recruited patients, 164 were male and 182 female. The prevalence of confirmed single aetiological agents for male urethritis was as follows: N. gonorrhoeae, 35%; C. trachomatis, 10%; and M. genitalium 4%. For vaginal discharge, N. gonorrhoeae was found in11% of the women tested, followed by C. trachomatis (6.5%), bacterial vaginosis (34%), and T. vaginalis (2%). The prevalence of genital ulcers was as follows: Herpes simplex virus type 2, 62%; H. ducreyi 4 %; and C. trachomatis biovar LGV, 4%. Five percent of patients with genital ulcers had a positive syphilis serology (RPR ≥ 1:8 and confirmed by TPHA) and 35% of all tested patients were HIV-1/2 infected. Cases of mixed infections were present in 5%, 11% and 3% of patients with male urethritis, vaginal discharge, and genital ulcers respectively. Conclusion: The classic sexually transmitted infection aetiologies are still prevalent in Maputo. The study highlights the need for a periodic surveillance to inform syndromic management protocols.

Background: Symptomatic vulvovaginal candidiasis (VVC) is one of the most common problems leading women to seek advice in primary healthcare facilities. Aim: The aim of this study is to describe the associations between some hypothesized factors and the presence of symptomatic VVC. Subjects and Methods: An analytical cross‑sectional study was conducted. A total of 90 women diagnosed with symptomatic VVC and 108 women without symptomatic VVC were recruited when attending Umlazi D clinic, a primary health clinic in KwaZulu‑Natal, South Africa between June 2011 and December 2011. Confirmed symptomatic VVC was determined by Gram stain and microbiological culture of vaginal swabs. For human immunodeficiency virus (HIV)‑infected women, HIV ribonucleic acid load in plasma and genital fluid was determined by real‑time‑polymerase chain reaction (BioMerieux, Lyon, France). CD4 counts were obtained from patients’ medical records. Data were analyzed using the statistical package for the social sciences (SPSS) version 21.0 (SPSS Inc.; Chicago, IL, USA). Multiple logistic regression models were used to exclude univariate confounders. All tests were two‑sided and a P < 0.05 was considered to be significant. Results: A total of 90% (81/90) of patients with symptomatic VVC complained of vulval itching, soreness and vaginal discharge when compared to 75.9% (82/108) of patients without symptomatic VVC (P < 0.01).Whilst pregnancy was independently associated with symptomatic VVC (P < 0.01), the latter was inversely related to Nugent’s scores (P < 0.01). When compared with HIV negative women, the odds for symptomatic VVC increased among women with HIV‑associated immunocompromise (CD4 counts < 200 cells/mm3, P < 0.001), significantly shedding HIV in their genital tracts (P = 0.04), with plasma HIV load > 1000 copies/mL (P < 0.001). There was a significant negative association between the use of highly active anti‑retroviral therapy and the presence of symptomatic VVC in HIV‑infected women (P < 0.01). Conclusion: Although symptomatic VVC is not classified as acquired immunodeficiency syndrome‑related condition, HIV‑related immune compromised women and particularly those who are anti‑retroviral therapy‑naïve are likely to develop symptomatic VVC.Keywords: Human immunodeficiency virus‑related immune suppression, Vulvovaginal candidiasis, Primary healthcare clinic

Background. Genital tract (GT) inflammation plays a major role in HIV transmission. We aimed to determine the association between symptomatic vulvovaginal candidiasis (VVC) and HIV RNA levels in plasma and GTs of HIV-infected women on highly active antiretroviral therapy (HAART). Method. Women with VVC on HAART were recruited from a primary healthcare clinic in KwaZulu-Natal Province, South Africa, between June 2011 and December 2011. VVC was diagnosed clinically, supported by Gram staining and culture of genital secretions. HIV RNA load was determined by reverse transcription polymerase chain reaction. CD4+ counts were obtained from patients’ medical records.Results. Plasma HIV RNA was detected in 42 of 60 (70%) patients on HAART. The mean duration (± standard deviation) on HAART for these patients was 4.2 (±1.6) months v. 10.7 (±1.4) months for the remaining 18 patients (p10 cells/5 high microscopic fields (p=0.007). Conclusion. Given that the majority of women had recently initiated HAART (allowing a high rate of detectable plasma HIV RNA), there was insufficient evidence to conclude that VVC was predictive of high plasma HIV RNA levels. It is more likely that this cohort of immunosuppressed women were prone to develop VVC. Plasma HIV loads and local genital inflammation were predictors of genital HIV detectability.

Introduction. We sought to determine the association between HIV-induced immunosuppression, virologic correlates, and vulvovaginal candidiasis (VVC).Methods. This is a retrospective cohort study, where HIV infected and uninfected women were studied with VVC being the primary outcome. Ninety-seven HIV-infected and 101 HIV-uninfected women were enrolled between June and December 2011. Cases of VVC were confirmed. HIV RNA load was determined by RT-PCR and CD4 counts were obtained from medical records.Results. Fifty-two of 97 (53.6%) HIV-infected and 38/101 (37.6%) HIV-uninfected women were diagnosed with VVC (P=0.032). The relative risk for VVC amongst HIV-infected patients was 1.53 (95% CI: 1.04–2P=0.024). Cases of VVC increased at CD4+ T cell count below 200 cells/mm3(P<0.0001) and plasma HIV RNA load above 10 000 copies/mL (P<0.0001). VVC was associated with increased genital shedding of HIV (P=0.002), and there was a linear correlation between plasma HIV load and genital HIV shedding (r=0.540;R2=0.292;P<0.0001). Women on HAART were 4-fold less likely (P=0.029) to develop VVC.Conclusion. CD4 counts below 200 cells/mm3and plasma HIV loads ≥10 000 copies/mL were significantly associated with VVC.

To ascertain the effectiveness of kanamycin for the treatment of gonorrhoea in Maputo, Mozambique.A cross-sectional study design was employed. Urethral and cervical specimens were collected for the isolation of Neisseria gonorrhoeae from patients attending Centro de Saúde do Porto. Antimicrobial susceptibilities were determined for kanamycin, spectinomycin, ciprofloxacin, ceftriaxone, cefixime, tetracycline and penicillin.Twenty-two (40%) Neisseria gonorrhoeae isolates were intermediate and 4(7%) were resistant to kanamycin; 42(77%) displayed high level resistance to tetracycline (MICor = 16 mg/L); 34 (65%) were penicillinase producers, and 52 (95%) had spectinomycin MICs of 64 mg/L. All isolates were susceptible to ciprofloxacin (MICor = 0.06 mg/L), ceftriaxone (MICor = 0.015 mg/L) and cefixime (MICor = 0.015 mg/L).The observations underscore the need for broader susceptibility surveillance studies to elucidate the pattern and extent of drug resistance in Mozambique. A review of the current treatment guidelines for genital discharge syndrome is warranted.

Salmonella enterica serotype Enteritidis is a universally recognized cause of foodborne disease. In South Africa, outbreaks of foodborne disease are generally under reported. We investigated the etiology of acute gastroenteritis in 216 patients who presented to a rural hospital in KwaZulu-Natal, South Africa, after consuming a meal at a school function.Stool specimens from 37 patients, as well as two food samples, were available for microbiological investigation. Similarity between isolates was investigated using phenotypic and genotypic techniques. Phenotypic investigations included morphological, biochemical, and antibiogram profiling. Genotypic relatedness was determined with pulsed-field gel electrophoresis analysis. The available epidemiological data were also described.Salmonella Enteritidis was isolated from 18 patients and 1 food sample. Isolates were phenotypically and genotypically indistinguishable. Epidemiological data suggest a point-source outbreak with a possibility of continued transmission.The results suggest a foodborne Salmonella Enteritidis outbreak due to contaminated food served at the school function. Epidemiological investigations continue to be extremely difficult in rural areas.