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Background Enterococci become clinically important especially in immune compromised patients and important causes of nosocomial infections. Data on the prevalence, antimicrobial susceptibility patterns and associated factors of enterococci are scarce in Ethiopia. Methods A hospital based cross-sectional study was conducted at the University of Gondar Teaching Hospital from February 28, 2014 to May 1, 2014. Pretested structured questionnaire was used to collect socio-demographic data and possible associated factors of enterococci infections. Clinical samples including urine, blood, wound swabs and other body fluids from patients requested by physician for culture and antimicrobial susceptibility test during the study period were included. A total of 385 patients were included in the study. Data were entered and analyzed using SPSS Version 20. P values

Background Artemether–lumefantrine (AL) has been used as a first-line treatment for uncomplicated Plasmodium falciparum malaria in Ethiopia since 2004. Antimalarial drug resistance is one of the major obstacles for malaria control and curtails the lifespan of several drugs. Thus, continued monitoring of the efficacy of AL is of great public health importance in malaria endemic areas. Objective This study aimed to investigate the therapeutic efficacy and safety of AL for the treatment of uncomplicated P. falciparum malaria in the Dembia district, northwest Ethiopia. Methods A prospective study was conducted from April 2015 to February 2016 at Kola Diba Health Center (KHC) in the Dembia district to determine the therapeutic efficacy and safety of AL for the treatment of uncomplicated P. falciparum monoinfection. Patients were treated with the six-dose regimen of AL over 3 days and followed up for 28 days as per the World Health Organization protocol. Results Of the total 80 patients enrolled in the AL efficacy study, 75 patients completed the 28 days follow-up. None of the participants reported major adverse events. No early treatment failure or late clinical failure were observed during the study, but there were 6 (8.0%) late parasitological failures. The uncorrected per protocol cure rate of AL was 92.0 (95% CI: 85.7–98.3). Treatment with AL cleared parasitemia and fever in >95% of the patients by day 3. Conclusion This study showed that AL is well tolerated and remains efficacious for treatment of uncomplicated P. falciparum malaria in northwest Ethiopia. However, the observed late parasitological failures in this study are of a concern and warrant continued monitoring of drug efficacy as per the World Health Organization recommendations.

Background: Artemether-lumefantrine (AL) has been used as a first-line treatment for uncomplicated Plasmodium falciparum malaria in Ethiopia since 2004. Antimalarial drug resistance is one of the major obstacles for malaria control and curtails the lifespan of several drugs. Thus, continued monitoring of the efficacy of AL is of great public health importance in malaria endemic areas. Objective: This study aimed to investigate the therapeutic efficacy and safety of AL for the treatment of uncomplicated P. falciparum malaria in the Dembia district, northwest Ethiopia. Methods: A prospective study was conducted from April 2015 to February 2016 at Kola Diba Health Center (KHC) in the Dembia district to determine the therapeutic efficacy and safety of AL for the treatment of uncomplicated P. falciparum monoinfection. Patients were treated with the six-dose regimen of AL over 3 days and followed up for 28 days as per the World Health Organization protocol. Results: Of the total 80 patients enrolled in the AL efficacy study, 75 patients completed the 28 days follow-up. None of the participants reported major adverse events. No early treatment failure or late clinical failure were observed during the study, but there were 6 (8.0%) late parasitological failures. The uncorrected per protocol cure rate of AL was 92.0 (95% CI: 85.7-98.3). Treatment with AL cleared parasitemia and fever in >95% of the patients by day 3. Conclusion: This study showed that AL is well tolerated and remains efficacious for treatment of uncomplicated P. falciparum malaria in northwest Ethiopia. However, the observed late parasitological failures in this study are of a concern and warrant continued monitoring of drug efficacy as per the World Health Organization recommendations.

Background.The widespread uses of antibiotics, together with the length of time over which they have been available, have led to the emergence of resistant bacterial pathogens contributing to morbidity and mortality. This study was aimed to assess bacterial isolates and their drug susceptibility patterns from inpatients and outpatients with pus and/or wound discharge.Methods.A cross-sectional study was conducted at the University of Gondar Referral Hospital from March to May, 2014. Wound swab samples were collected from each study participant and inoculated into appropriate media. The bacterial pathogens were identified using standard microbiological methods. Antimicrobial susceptibility tests were performed using disk diffusion technique following Kirby-Bauer method.Results.A total of 137 study subjects were included in the study with bacterial isolation rate of 115 (83.9%). Of all, 81 (59.1%) were males. Seventy-seven (57%) of the isolates were Gram-negative and 59 (43%) were Gram-positive. From the total isolates,Staphylococcus aureuswas the most predominant isolate 39/115 (34%) followed by Klebsiella species (13%), coagulase negative staphylococci spp. (12%) andPseudomonas aeruginosa. Gram-positive isolates were resistant to ampicillin (86.4%), amoxicillin (83%), penicillin (81.3%), oxacillin (74.6%), and tetracycline (59.4%), while Gram-negative isolates were resistant to amoxicillin (97.4%), ampicillin (94.8%), tetracycline (72.7%), trimethoprim/sulfamethoxazole (66%), and chloramphenicol (54.5%).Conclusion. High prevalence of bacterial isolates was found,Staphylococcus aureusbeing the most dominant. High rates of multiple drug resistance pathogens to the commonly used antimicrobial agents were isolated. Therefore, concerned bodies should properly monitor the choice of antibiotics to be used as prophylaxis and empiric treatment in the study area.

Background In endemic regions, asymptomatic Leishmania infection is common. In HIV patients, detection of asymptomatic Leishmania infection could potentially identify those at risk of visceral leishmaniasis (VL). However, data on the prevalence, incidence, and determinants of asymptomatic infection, and the risk of VL are lacking. Methods We conducted a cross-sectional survey at a single ART centre, followed by a prospective cohort study amongst HIV-infected adults in HIV care in a district hospital in a VL-endemic area in North-West Ethiopia (9/2015-8/2016). Asymptomatic Leishmania infection was detected using the direct agglutination test (DAT), rK39-rapid diagnostic test (RDT)), PCR on peripheral blood and the KAtex urine antigen test, and defined as positivity on any Leishmania marker. All individuals were followed longitudinally (irrespective of the Leishmania test results). Risk factors for asymptomatic Leishmania infection were determined using logistic regression. Results A total of 534 HIV-infected individuals enrolled in HIV care were included in the study. After excluding 13 patients with a history of VL and an 10 patients with incomplete baseline Leishmania tests, 511 were included in analysis. The median age was 38 years (interquartile range (IQR) 30–45), 62.6% were male. The median follow-up time was 12 months (IQR 9–12). No deaths were reported during the study period. Most (95.5%) were on antiretroviral treatment at enrolment, for a median of 52 months (IQR 27–79). The median CD4 count at enrolment was 377 cells/mm3 (IQR 250–518). The baseline prevalence of Leishmania infection was 12.8% in males and 4.2% in females. Overall, 7.4% tested positive for rK39, 4.3% for DAT, 0.2% for PCR and 0.2% for KAtex. Independent risk factors for a prevalent infection were male sex (odds ratio (OR) 3.2; 95% confidence intervals (CI) 14–7.0) and concurrent malaria infection (OR 6.1; 95% CI 1.9–18.9). Amongst the 49 prevalent (baseline) infections with further follow-up, the cumulative incidence of losing the Leishmania markers by one year was 40.1%. There were 36 incident infections during the course of the study, with a cumulative one-year risk of 9.5%. Only one case of VL was detected during follow-up. Conclusions We found a high prevalence of asymptomatic Leishmania infection, persisting in most cases. The incidence was more modest and overt VL was rare. Larger and longer studies with more complete follow-up may help to decide whether a test and treat strategy would be justified in this context. Trial registration ClinicalTrials.gov NCT02839603, Author summary As visceral leishmaniasis (VL) in HIV patients is difficult to treat and associated with high mortality, strategies to detect and treat asymptomatic Leishmania infection in HIV patients should be explored. However, data on the prevalence, incidence, determinants of asymptomatic infection and risk of VL are lacking. We conducted a longitudinal study, including HIV-infected adult patients in HIV care in a district hospital in a VL-endemic area in North-West Ethiopia. Asymptomatic Leishmania infection was evaluated by Leishmania antibody tests (DAT and rK39), urine antigen tests (KAtex) and PCR, and was defined as positivity on any Leishmania marker. We also looked for independent risk factors for asymptomatic Leishmania infection at study recruitment. A total of 511 patients were included in the analysis. The median age was 38 years, 62.6% were male. The median time of residence in a VL-endemic area was 18 years. Most (95.5%) were on antiretroviral treatment at enrolment, for a median of 52 months. The median CD4 count at enrolment was 377 cells/mm3. The baseline prevalence of Leishmania infection was 12.8% in males and 4.2% in females. Overall, 7.4% tested positive for rK39, 4.3% for DAT, 0.2% for PCR and 0.2% for KAtex. Independent risk factors for a prevalent infection were male sex and concurrent malaria infection. Amongst the 49 prevalent infections that were present upon enrolment in the study, the probability of losing the Leishmania markers by one year was 40.1%. There were 36 new infections during the course of the study, with an overall risk of 9.5% by one year of follow-up. One case of VL was detected during follow-up. In conclusion, we found a high prevalence of asymptomatic Leishmania infection, which persisted in most cases. The incidence was more modest. Larger and longer studies would be needed to decide whether a test and treat strategy would be justified in this context.

Objectives Empirical selections of antimicrobial therapy based on clinical observations are common clinical practices in Ethiopia. This study identified common external ocular infections and determined antibiotic susceptibility testing in northwest Ethiopia. Results Among 210 patients studied, conjunctivitis 32.9%(69), blepharitis 26.7%(56), dacryocystitis 14.8%(51), blepharoconjunctivitis 11.9%(25), and trauma 10.0%(21) were the most common external ocular infections. Pathogenic bacteria were isolated among 62.4%(131) cases. The distributions of bacteria detected in conjunctivitis, dacryocystitis, and blepharitis patients were 32.8%(43), 23.7%(31), and 16.0%(21), respectively. The most prevalent isolates were coagulase negative Staphylococci; 27.5%(36), S. aureus; 26.7%(35), Pseudomonas species; 10.7%(14), and E. coli; 7.6%(10). Tetracycline, amoxicillin, chloramphenicol, ampicillin, and nalidic acid showed resistance to bacterial isolates with a respective prevalence of 35.9%(47), 32.1%(42), 26.2%(34), 25.2%(33), and 23.7%(31). Multi-drug resistance patterns to the commonly prescribed antibiotics tested was 20.6%(27), 18.3%(24), 17.6%(23), 5.3%(7), and 4.6%(6) to two, three, four, five, and six antibiotics, respectively. Overall, the multi-drug resistance prevalence rate was 66.4%(87). This study confirmed diverse types of external ocular manifestations associated with bacterial infections with wide ranges of antibiotic resistant phenotypes. Thus, combining clinical information, bacteriological analysis, and antimicrobial susceptibility tests are useful for making an evidence-based selection of antibiotics therapy. Electronic supplementary material The online version of this article (10.1186/s13104-018-3705-y) contains supplementary material, which is available to authorized users.

Additional file 1. Comparison of the distribution of the sociodemographic and external ocular infections with total bacteria isolates and associated antibiotic resistance profiles.

The approach to treatment of visceral leishmaniasis (VL)-HIV co-infection in East Africa has not been systematically examined. Although antiretroviral treatment (ART) should be initiated for all co-infected persons, the extent of ART prescription is not known. We conducted a retrospective cohort study including all VL–HIV co-infected adults at selected referral and district hospitals in northwest Ethiopia from 2010 to 2015. Purposes of the study were to compare the proportion of VL diagnoses made in previously diagnosed HIV-patients versus diagnosis concurrent with HIV diagnosis and to quantify utilization of ART. We included 112 patients and 58 patients at the referral and district hospital, respectively (median age: 30 years, 98% males). Of all VL cases, 56% (63/112) and 19% (11/58) occurred in known HIV patients at the referral and district hospital, respectively, with a median CD4 count at VL diagnosis of 45 cells/µL and 248 cells/µL at the referral and district hospital, respectively. Seventy-six percent (56/44) were on ART at VL diagnosis and nine (12%) started ART after VL diagnosis. The remaining 96 (56%) patients had both infections diagnosed concurrently, with a median CD4 count of 56 and 143 cells/µL at the referral and district hospital, respectively. Among cured patients, ART initiation was 67% and 36% at the referral and district hospital, respectively. A substantial proportion of VL–HIV cases occur while in HIV care, requiring further evaluation of preventive strategies. Among newly diagnosed VL–HIV co-infected patients, ART initiation was low. The reasons, including poor documentation and information exchange, should be assessed.

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Sepsis is one of the major causes and predictors of death in patients with visceral leishmaniasis (VL). Globally, incidence rate of sepsis ranged from 56–91 cases per 100 000 people, with a mortality rate of 30%. Incidence of sepsis has been raised due to aging of the population and the higher incidence of immunosuppressive conditions such as HIV, VL and others. The prevalence of sepsis was reported from 4.2% to 32.3% and 14.1% in VL and VL-HIV coinfected patients, respectively. The mortality rate of VL patients with sepsis is greater than 50%. Factors associated with sepsis in VL patients are immune suppression, pancytopenia, HIV co-infection, age 40 years old, indwelling of central venous lines and hospitalization. Although antimicrobial susceptibility patterns were not well reported, both Gram-positive and Gram-negative bacteria were isolated from patients with VL. So far, limited information is available on sepsis in VL, especially in VL-HIV coinfected patients. Therefore, further studies about sepsis prevalence, causative agents and their antibiotic patterns, and associated factors among VL and VL-HIV coinfected patients are necessary. This review provides information about bacterial sepsis in patients with VL.

Objective. The aim of this study was to evaluate the operational characteristics (sensitivity and negative predictive value (NPV)) of wet mount, formol-ether concentration (FEC), and Kato-Katz techniques for the determination of intestinal parasitic infections. Method. A total of 354 faecal specimens were collected from students in Northwest Ethiopia and screened with Kato-Katz, wet mount, and FEC for the presence of intestinal parasitic infection. Since a gold standard test is not available for detection of intestinal parasites, the combined results from the three methods were used as diagnostic gold standard. Result. The prevalences of intestinal parasites using the single wet mount, FEC, and Kato-Katz thick smear techniques were 38.4%, 57.1%, and 59%, respectively. Taking the combined results of three techniques as a standard test for intestinal parasitic infection, the sensitivity and negative predictive value of Kato-Katz is 81.0% (confidence interval (CI) = 0.793–0.810) and 66.2% (CI = 0.63–0.622), respectively. The FEC detected 56 negative samples that were positive by the gold standard, indicating 78.3% (CI = 0.766–0.783) and 63.2% (CI = 0.603–63) sensitivity and NPV, respectively. Furthermore, Kato-Katz detects 113 cases that were negative by a single wet mount. The κ agreement between the wet mount and Kato-Katz methods for the diagnosis of Ascaris lumbricoides and hookworm was substantial (κ=0.61 for Ascaris lumbricoides, κ=0.65 for hookworm).

Objective. To assess the magnitude of intestinal parasitic infection and associated risk factors in Teda Health Centre, Northwest Ethiopia. Method. A cross-sectional study was conducted in Teda Health Centre from February to April, 2011. Stool samples were collected from 410 study participants and analysed by direct wet mount and formal ether concentration techniques. Furthermore, sociodemographic data were collected by using standardized questionnaire. Result. The overall prevalence of intestinal parasitic infection in this study was 62.3%. Ascaris lumbricoides was the most predominant parasite (23.2%) followed by Giardia intestinalis (12.4%), Entamoeba histolytica/dispar (4.6%), Schistosoma mansoni (8.9%), hookworm (6.6%), Hymenolepis nana (1.5%), Enterobius vermicularis (0.4%), and Strongyloides stercoralis (0.2%). Absence of toilet and hand washing after toilet was shown to be associated with intestinal parasitic infection ( for both). Furthermore, swimming and less shoe wearing habits showed a significant prevalence of S. mansoni and hookworm infections, respectively. Conclusion. The present study showed high prevalence of intestinal parasitic infection in the study area. Absence of toilet and hand washing after toilet was found to be associated with intestinal parasitic infection. Therefore, there is a need for integrated control programme to have a lasting impact on transmission of intestinal parasitic infection.

To assess the magnitude and antimicrobial susceptibility patterns of Streptococcus pneumoniae isolates from various clinical specimens.A record based on retrospective study was conducted at Gondar University Teaching Hospital from September 2007 to January 2012. All patients who visited Gondar University Hospital and provided clinical specimens (body fluids, discharge, swab and blood) for routine bacteriological culturing and antimicrobial susceptibility testing were taken for analysis. Clinical specimens were processed for bacterial culture according to the standard procedures. Antimicrobial susceptibility test for isolated organisms was done using agar disk diffusion method. The data were entered and analyzed using SPSS software version 16 package.One hundred and fifty three Streptococcus pneumoniae were isolated from patients who visited Gondar University Teaching Hospital bacteriology laboratory for culture. Majority of the pneumococcal isolates were from inpatients [111(72.5%)], and 74(48.4%) were from body fluids. Out of the total isolates, 93(61%) were found to be resistant to at least one antibiotic used for susceptibility testing. Forty eight (43.2%) of the isolates were multi-drug resistant (resistant to two or more drugs). The resistance rate noted for both ciprofloxacin 17(11.1%) and ceftriaxone 15(9.8%) were alarming.High proportions of the isolates tend to be increasingly resistant to the commonly prescribed drugs. The recommended drug of choice like ciprofloxacin and ceftriaxone were found to be less susceptible in the study area. Based on the findings, we therefore recommend that antimicrobial agents should be inspected for acceptable activity before they are prescribed and administered empirically. Further study with a better design and survey of antimicrobial susceptibility at large scale shoule be performed to draw advanced information.

Background Ethiopia is one of the countries that are highly affected by dual epidemics of human immunodeficiency virus (HIV) and tuberculosis (TB). HIV infection is a known risk factor for the development of active TB and it challenges in diagnosis and treatment of TB. Thus, it is essential to determine the epidemiology of HIV infection among TB patients to guide clinical actions and inform the policy makers. This study was aimed to assess the prevalence of HIV infection among TB patients and to describe the associated risk factors for HIV seropositivity. Methods A retrospective study was conducted on TB registries at Metema Hospital directly observed therapy short-course (DOTS) clinic. Binary and multivariate logistic regression analysis was used to determine the association of HIV seropositivity among TB patients. Odds ratio (OR) and 95 % confidence intervals (CI) were calculated. P value less than 0.05 was considered as statistically significant. Results Of the total 2096 pateints, 2005 (95.7 %) were tested for HIV. The overall HIV–TB co-infection rate was 20.1 % (404), 12.3 % (246) in males and 7.9 % (158) in females. The highest proportion of co-infection rate was observed among the patients in the age group of 25–34 years (32.4 %) and smear negative pulmonary TB patients (59.7 %). A declining trend of HIV–TB co-infection was observed during the study period, from 22.1 % (185) in 2009/10 to 12.8 % (52) in 2011/12 (X2 = 17.07, P

Background. Bacterial sepsis is a major cause of illness in human immunodeficiency virus infected patients. There is scarce evidence about sepsis among HIV patients in Ethiopia. This study aimed to determine the etiologic agents of bacterial sepsis and their antibiotic susceptibility patterns among HIV infected patients.Methods. A cross-sectional study was carried out from March 1 to May 2, 2013. One hundred patients infected with HIV and suspected of having sepsis were included. Sociodemographic data were collected by interview and blood sample was aseptically collected from study participants. All blood cultures were incubated aerobically at 35°C and inspected daily for 7 days. The positive blood cultures were identified following the standard procedures and antimicrobial susceptibility testing was performed using disk diffusion technique. Data was entered by Epi-info version 3.5.1 and analysis was done using SPSS version 20.Results. Of the study participants, 31 (31%) confirmed bacterial sepsis. The major isolates were 13 (13%)Staphylococcus aureus, 8 (8%) coagulates negative staphylococci, and 3 (3%) viridans streptococci. Majority of the isolates, 25 (80.6%), were multidrug resistant to two or more antimicrobial agents.Conclusions. Bacterial sepsis was a major cause of admission for HIV infected patients predominated byStaphylococcus aureusand coagulase negative staphylococci species and most of the isolates were multidrug resistant.

Background. Cockroaches are source of bacterial infections and this study was aimed to assess bacterial isolates and their antimicrobial profiles from cockroaches in Gondar town, Ethiopia.Methods. A total of 60 cockroaches were collected from March 1 to May 30, 2014, in Gondar town. Bacterial species were isolated from external and internal parts of cockroaches. Disk diffusion method was used to determine antibiotic susceptibility patterns. Data were entered and analyzed by using SPSS version 20;Pvalues Results. Of 181 identified bacteria species, 110 (60.8%) and 71 (39.2%) were identified from external and internal parts of cockroaches, respectively.Klebsiella pneumoniae32 (17.7%),Escherichia coli29 (16%), andCitrobacterspp. 27 (15%) were the predominant isolates. High resistance rate was observed to cotrimoxazole, 60 (33.1%), and least resistance rate was noted to ciprofloxacin, 2 (1.1%). Additionally, 116 (64.1%) of the isolates were MDR strains;Salmonellaspp. were the leading MDR isolates (100%) followed byEnterobacter(90.5%) andShigellaspp. (76.9%).Conclusion. Cockroaches are the potential source of bacteria pathogens with multidrug resistant strains and hence effective preventive and control measures are required to minimize cockroach related infections.

Background Syphilis and HIV infections in pregnancy result in a number of adverse outcomes including neonatal death and vertical transmission. Ethiopia is a country where these infections are highly prevalent. However, data on co-morbidities of syphilis and HIV among pregnant women in Gondar are scarce. Thus, the aim of this study was to determine the seroprevalence of these infections and associated factors among pregnant women attending antenatal care at the University of Gondar teaching hospital, Northwest Ethiopia. Methods A cross sectional study was conducted from February to June 2011. Structured interviews were used to collect socio-demographic and obstetric data. Sera against syphilis were screened by rapid plasma reagin test; and confirmed by Treponema pallidum hemagglutination assay. HIV infection was detected by rapid HIV test kits following the national algorithms for HIV testing. Data were summarized by descriptive statistics and binary logistic regression. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. Results Of 385 pregnant women, reactive syphilis was noted in 11/385 (2.9%) and seroprevalence of HIV was 43/385 (11.2%). The prevalence of syphilis and HIV co-infection was 2/385(0.5%). High rate of syphilis was observed among the women with above 30 years of age (OR 3.69, 95% CI 0.83 - 16.82). Women with a history of miscarriage and stillbirth were more likely to be infected by syphilis (OR 2.22, 95% CI 0.54-9.60) and (OR 3.24, 95% CI 0.00-17.54), respectively. Conclusion Our data indicated that syphilis and HIV infections are still important public health concerns among pregnant women in the Gondar area. Hence, we recommend strenuous screening of all pregnant women for these infections during antenatal care. Further, strengthening health education on the mode of transmission and prevention of HIV and syphilis is essential for effective control of these infections.

usc Refereed/Peer-reviewed Background: Updates on the epidemiology of antibiotic resistance bacterial pathogens is important. This is because the spread of multidrug resistant enterobacteriaceae (MDRE) and recently carbapenemase producing enterobacteriaceae (CPE) have emerged as a major public health concern in patients with urinary tract infections (UTIs). This study is therefore, aimed to assess the prevalence and associated risk factors of MDR and CPE among patients with UTIs. Methods: A cross sectional study was conducted among 442 symptomatic UTI suspected patients. Data on socio-demographic characteristics, clinical information and possible risk factors were collected using structured questionnaire. Early morning mid-stream urine samples were collected and processed to characterize bacterial isolates. Disk diffusion method was used to determine the antibiotic susceptibility patterns of isolates. Carbapenemase producing strains were detected using CHROMagar KPC medium. Data were entered and analyzed using SPSS version 20. P-value

In September 2012, a novel coronavirus was recognized, later renamed Middle East Respiratory Syndrome Coronavirus. This novel coronavirus belong lineage C of the genus Beta coronavirus included virus isolates from bats and camels. Fever, cough and shortness of breath were the common initial symptoms. On the other hand, majority of Patients were rapidly progressed to severe pneumonia and renal failure. Dromedary camels are suspected the primary reservoir for MERS CoV infection; suggesting camels to human transmission via contact with their excretion and consuming their product. However, human to human transmission occurred via the respiratory droplet or close contact. There is no specific drug or vaccine available for illnesses caused by MERS-CoV infection. Currently this novel virus is the major emerging respiratory pathogen threats of the world and capable of lethal human infections. Still new cases have been reported around the world particularly Arabian Peninsula. It has been also emerged outside Middle East countries which have not occurred before in South Korea and China since 20 May, 2015.

Background: Sexually transmitted infection (STI) is a major global cause of acute illness, infertility, long-term disability and death, with serious medical and psychological consequences to millions of men, women and infants. Moreover, in Ethiopia, epidemiological studies on STI among STI clinic clients are limited. Therefore, the aim of this study was to determine the prevalence and associated risk factors of sexually transmitted infection (STI).Methods: A cross sectional study was conducted between April and August 2014 among STI clinic clients in Gondar Town hospitals and health centers. One hundred twenty study participants who fulfill the criteria were included. Different laboratory methods and techniques were applied to identify the possible microorganisms. Data were entered and analyzed using SPSS version 20. Logistic regression was used to determine risk factors for STI and P values < 0.05 was considered statistically significant.Results: The overall laboratory test confirmed that STIs prevalence was 74.1% with 32.5% being Candida spp., 30% T. palladium, 20.8% N. gonorrhoeae and 14.2% T. vaginalis. Two or more organisms were isolated in 20% of the study subjects. Risk factors for STI had knowledge about STI and alcohol consumption.Conclusion: The prevalence of N. gonorrhoeae, T. pallidum, T. vaginalis, and Candida spp. in the study area was high. It needs health education programs, promotes condom utilization and more comprehensive community based STI studies.Keywrds: STI, Candida spp., N. gonorrhoeae, T. pallidum, T. vaginalis

Background: Visceral leishmaniasis (VL) causes considerable morbidity and mortality in Ethiopia. Data on the prevalence and associated risk factors on malnutrition among VL patients in Ethiopia are scarce. This study aimed to assess the prevalence of malnutrition and its associated risk factor among VL patients in Northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted from June to September 2012 at four leishmaniasis treatment sites in Northwest Ethiopia. Four hundred and three adult VL patients were enrolled in the study. Malnutrition was defined as a body mass index (BMI) ≤18.5 kg/m2. The data collected from the VL patients included sex, age, residence, occupation, weight, height, laboratory results (HIV, hemoglobin, intestinal parasites). Multivariate logistic regression model was used to determine the strength of association between malnutrition and associated risk factors. Results: Among 403 adult VL patients 385 (95.5%) were malnourished. Twenty eight percent (n = 113), 30.3% (n = 122), and 37.2% (n = 150) were mildly, moderately and severely malnourished, respectively. The prevalence of intestinal parasitic infection was 47.6% (n = 192) and it was associated with malnutrition (P = 0.01). The prevalence of VL-HIV co-infection was 10.4% (n = 42). Hook worm, Giardia intestinalis and Ascaris lumbircoides were the leading prevalent intestinal parasites. Factors such as age, sex, residence, occupation, HIV status and anemia were not associated with severe malnutrition. Conclusions: The prevalence of malnutrition in VL patients was very high and it was associated with intestinal parasitic infections. Therefore, screening of severely malnourished VL patients for intestinal parasitic infections during admission is recommended.

Background. Intestinal schistosomiasis is one of the most widespread parasitic infections in tropical and subtropical countries.Objective. To determine the prevalence ofS. mansoniinfection and associated determinant factors among school children in Sanja Town, northwest Ethiopia.Methods. A cross-sectional study was conducted from February to March, 2013. 385 school children were selected using stratified proportionate systematic sampling technique. Pretested questionnaire was used to collect sociodemographic data and associated determinant factors. Stool samples were examinedusing formol-ether concentration and Kato-Katz technique. Data were entered and analyzed using SPSS 20.0 statistical software. Multivariate logistic regression was done for assessing associated risk factors and proportions for categorical variables were compared using chi-square test.Pvalues less than 0.05 were taken as statistically significant.Results. The prevalence ofS. mansoniinfection was 89.9% (n=346). The overall helminthic infection in this study was 96.6% (n=372). Swimming in the river, washing clothes and utensil using river water, crossing the river with bare foot, and fishing activities showed significant association with the occurrence ofS. mansoniinfection.Conclusion.Schistosoma mansoniinfection was high in the study area. Therefore, mass deworming at least twice a year and health education for community are needed.

Background: Tuberculosis (TB) is a major public health problem in Amhara region, Ethiopia where the TB case detection rate is low (22%). This situation has been worsened by the emergence and spread of drug resistance strains which have been threatening efforts of TB control. Objectives: The aim of this study was to assess the magnitude of drug resistance patterns of M. tuberculosis in Eastern Amhara region, Ethiopia. Methods: A facility based cross sectional study was conducted among 230 (165 new and 65 retreated) smear positive TB patients (age ≥18 years old) from September 2010 to June 2011. Socio-demographic data of the study participants and possible factors for development of drug resistance were collected using pre-tested structured questionnaire. Smear positive sputum samples were processed and decontaminated by the modified Petrof method. Primary isolation and drug susceptibility testing (DST) were carried out on egg based Lowenstein –Jensen media (LJ). Data were entered and analyzed using SPSS version 16 software. Multivariate analysis using the logistic regression model was computed. P-values less than 0.05 were considered as statistically significant. Results: The overall prevalence of drug resistance to at least a single drug was 77/230(33.5%). The prevalence of MDR-TB in all, new and re-treated patients was 15/230(6.5%), 3/165(1.8%) and 12/65 (18.5%), respectively. In the multivariate analysis previous exposure to anti-TB drugs and 1+ bacterial load were significantly associated with anti TB drug resistance (P

Introduction. Asymptomatic malaria is prevalent in highly endemic areas of Africa and is new challenge for malaria prevention and control strategies. Objective. To determine the prevalence of asymptomatic malaria and associated risk factors among school children in Sanja Town, northwest Ethiopia. Methods. A cross-sectional study was conducted from February to March 2013, on 385 school children selected using stratified proportionate systematic sampling technique. Pretested questionnaire was used to collect sociodemographic data and associated risk factors. Giemsa-stained thin and thick blood films were examined for detection, identification, and quantification of malaria parasites. Data were entered and analyzed using SPSS 20.0 statistical software. Multivariate logistic regression was done for assessing associated risk factors and proportions for categorical variables were compared using chi-square test. P values less than 0.05 were taken as statistically significant. Results. The prevalence of asymptomatic malaria was 6.8% (n=26). The majority of parasitemic study participants had low parasite density 65.5% (17/26). Level of grade, age, bed net usage, and frequent exposure to malaria infection were associated with risk of asymptomatic malaria. Conclusion. Asymptomatic malaria was low in this study area and is associated with level of grade, age, bed net usage, and frequent exposure to malaria infection.

Background: Despite the availability of effective drugs, tuberculosis remains to be a major public health problem in the world. This study sought to determine treatment outcomes and to investigate associated factors for poor treatment outcomes among TB patients in Northwest Ethiopia. Method: A retrospective cohort study was conducted using medical records of TB patients who registered and treated at Metema hospital. Bivariate and multivariate analysis was used to determine predictors of unsuccessful outcomes. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. P value less than 0.05 was considered as statistically significant. Results: Of the total 2970 patients, 2657 (89.5%) were newly diagnosed TB cases; whereas 167 (5.7%) and 146 (4.9%) were re-treatment and transfer cases, respectively. About sixty percent of the patients were male. The median age (SD) of the patients were 28 years (14.38) and 30.7% of patients were within the age group of 25-34 years. Five hundred eight (20.1%) TB patients were co-infected with HIV. With respect to the treatment outcomes, 65.3% were successfully treated, 88 (3.0%) died, 107 (3.3%) defaulted, 22 (0.7%) failed and 814 (27.4%) were transferred out. A declining trend of treatment success rate (TSR) was observed, from 73.1% in 2009 to 54.5% in 2011/12. Co-infection with HIV (P=0.00) and being male (P=0.02) were associated with unsuccessful treatment outcomes. Conclusion: Treatment success rate (TSR) of TB patients was still low and a declining trend of TSR was observed over the study period. Co-infection with HIV and being male were found to be correlated with poor treatment outcomes. Thus, we recommend targeted medical interventions of the patients at high risk for the unfavorable treatment outcomes.

Background. In most hospitals of developing countries, urinary tract infections are treated empirically because of lack of culture facilities. This leads to emergence of multiresistant uropathogens. Culturing and drug susceptibility testing are essential to guide therapy. Objectives. To assess changing prevalence and resistance pattern of uropathogens to commonly used antibiotics in a two-year study period. Methods. Urine specimens were collected and cultured. Uropathogens were identified by standard methods and tested for antibiotics resistance. Data were analyzed using SPSS version 16 statistical sofware. P value < 0.05 was considered statistically significant. Results. The commonest isolates in both the previous and present studies were E. coli, Klebsiella, CoNS, S. aureus, Proteus, and Citrobacter species. Previous isolates of Enterobacteriaceae were 100% sensitive to ciprofloxacin, whereas present isolates developed 31% to 60% resistance to it. Previous isolates were less resistant to gentamycin than the present ones. Multiresistance isolates were predominant in present study than previous ones. Conclusion. E. coli was predominant in the two study periods. Present isolates were more resistant than previous ones. Some previous isolates were 100% sensitive to ciprofloxacin, whereas present isolates were increasingly resistant. Ciprofloxacin and gentamicin have been recommended for empiric treatment of urinary tract infections.

Background: Ethiopia is among the countries with the highest incidence of tuberculosis (TB) and has a early incidence of 379 cases/100,000 population. Of the high TB burden regions, Amhara is the top. So understanding the epidemiology of TB through molecular genotyping techniques such as Spoligotyping have invaluable role to combat TB. It will help to designing appropriate intervention and strengthen TB control program. Objectives: To provide insight about the genetic biodiversity of Mycobacterium tuberculosis, strain specific drug susceptibility and possible associated factors in Eastern Amhara region, Ethiopia. Methods: A facility based cross sectional study was conducted among smear positive TB patients (age ≥ 18 years old) from September 2011 to June 2012. Smear positive sputum samples were processed and decontaminated by the modified Petrof method. Primary isolation and drug susceptibility testing (DST) were carried out on egg based Lowenstein-Jensen (LJ). Genotyping of mycobacterial DNA was performed by spoligotyping and isolates were assigned to families using the SpolDB4 and the model-based program ‘Spotclust’. P-values less than 0.05 were considered as statistically significant. Result: The predominant Mycobacterium tuberculosis strains in the present study were ST 149/T3-ETH 49(22.6%), ST53/T1 18(8.3%) and ST50/H3 16(7.4%). T3-ETH strain showed the highest MDR-TB cases. Conclusion: Our finding suggests that a diversity of Mycobacterium tuberculosis strains accompanied with high rate of drug resistance.

Background Enterococci are the most important multidrug resistant organisms associated with immunocompromised patients. Data are lacking about the epidemiology of vancomycin resistant Enterococci (VRE) in Ethiopia. This study aimed to assess the prevalence of VRE, their susceptibility patterns to different antibiotics and associated risk factors in fecal samples of Human Immunodeficiency Virus (HIV) positive and HIV negative clients. Methods A cross sectional study was carried out in a total of 226 (113 HIV positive and 113 HIV negative) clients, from July 1/2013 to September 30/2013 at the University of Gondar Teaching Hospital. Data on socio-demographic characteristics and risk factors were collected with a short interview guided by pre-tested structured questionnaire. The enterococci were isolated and identified from stool sample using standard bacteriological procedures. Kary Bauer disk diffusion method was used to determine the susceptibility patterns of Enterococci isolates. Data were entered and analyzed using SPSS version 20 statistical package. Results The overall colonization of Enterococci was 88.9% (201/226) of which 11 (5.5%) were VRE. The prevalence of VRE among clients with and without HIV infections were 8(7.8%) and 3(3.1%), respectively. Ninety percent of the Enterococci isolates (181/201) were resistant to two or more antibiotics tested. Isolates of Enterococci recovered from stool samples of HIV infected patients were more resistant to amoxicillin and amoxicillin-calvulinic acid than HIV negative clients (P 0.05). Conclusion The high prevalence of VRE in this study signals the emergence of VRE in the study area. Prior antibiotic treatment was associated with VRE colonization. Therefore, rational use of antibiotics and more detailed study using phenotypic and genotypic methods are needed.

Infectious diseases of bacterial origin are a major cause of morbidity and mortality in developing countries such as Ethiopia. To minimise such burdens, proper use of antibiotics has played a vital role and saved countless lives. However, use of antimicrobials as therapeutic agents is compromised by the potential development of drug-resistant micro-organisms. Currently, antimicrobial drug resistance has become a public health concern both in developing and developed countries. Antimicrobial drug resistance is dramatically accelerated when antimicrobials are misused. This is critical, especially in developing countries where they are not only misused but are often underused due to financial constraints. Although large-scale studies on antimicrobial resistance in Ethiopia have not yet been conducted, the available reports indicate a trend towards increasing resistance rates among pathogens such as Escherichia coli, Shigella spp., Salmonella spp. and Staphylococcus aureus to commonly prescribed antibiotics, including ampicillin, amoxicillin, penicillin, tetracycline and trimethoprim/sulfamethoxazole. This review summarises the existing data on antibacterial drug resistance in this country.

Background and Objective. Schistosomiasis is highly prevalent in tropics and causes morbidity and mortality in developing countries including Ethiopia. This study is aimed to assess the current status of S. mansoni infections and associated risk factors among students in Gorgora town, Northwest Ethiopia. Method. A cross-sectional study was conducted from October 2010 to November 2010 at Gorgora, Northwest Ethiopia. All students (579) present during the study period were enrolled. Pretested questionnaires were used to collect sociodemographic data and predisposing factors. Stool examination was performed using wet mount and Kato-Katz techniques. Data were entered and analysed using SPSS version 20.0 statistical software. Result. Among 579 students enrolled, 291 (50.3%) were positive for one or more intestinal parasites. Prevalence of S. mansoni was found to be 20.6% with mean intensity of infection (125 eggs per gram of feces). Lack of awareness and water contact habits such as frequent swimming in the open water source, agricultural activities on bare foot, and washing clothes were also associated with high risk of S. mansoni infection. Conclusion. Even though there seems to be a decline in the prevalence of S. mansoni infections in the study area, the problem still persists and affects students significantly. Therefore, therapeutic intervention and health education are needed.

Background. Toxoplasma gondii is an obligate intracellular protozoan parasite and is a major opportunistic pathogen in immune-compromised hosts. This study assessed the prevalence of T. gondii and associated risk factors among people living with HIV. Methods and Materials. A cross-sectional study was carried out among people living with HIV attending Gondar University Hospital. A structured and pretested questionnaire was used to collect sociodemographic factors, and 10mL of venous blood was collected for anti-Toxoplasma antibody test and determination of CD4 levels. Serum was tested in duplicate for anti-Toxoplasma antibody using rapid slide agglutination test. Results. A total of 170 study subjects were enrolled in the study. Seroprevalence of T. gondii among the study participants was 76.5% (95% CI: 69.0–82.8). High proportions of seropositive individuals (64.7%) were found under the child bearing age groups. The mean CD4+ lymphocyte count of HIV monoinfected participants was cells/mm3 while coinfected study participants had mean CD4+ lymphocyte count of cells/mm3 with value of 0.01. Conclusion. The seroprevalence of T. gondii among people living with HIV was high. Cautious followup of HIV-positive patients is needed to prevent development of toxoplasmic encephalitis and other related complications.

Bacteremia due toShigellais rare. A 26-year-old HIV-negative male presented with a persistent high-grade fever of two months duration to the Leishmaniasis Research and Treatment Center of University of Gondar Hospital. He was anorexic and had lost significant weight (from 76 to 57 kg in 4 months, BMI = 17.2 kg/m2). He also complained of headache, chills, and rigor. In the last one year, he was experiencing a few episodes of acute bloody diarrhea, the last episode being two months ago. Microscopy from splenic aspiration showed Leishman-Donovan bodies with parasite load of +3. The blood culture showedShigellaspecies, but the stool was culture negative. The isolate was sensitive to most tested antibiotic discs, sulfamethoxazole, ceftriaxone, gentamicin, tetracycline, and norfloxacilin, except ampicillin. Therefore, requesting blood culture for identifying unexpected type of organisms causing infections in patients with underlying diseases like visceral leishmaniasis should be encouraged.

A bacteriocin-producing strain isolated from Ethiopian honey was identified as Enterococcus faecium. The incidence of multidrug resistance has become a leading challenge in the treatment of deadly infectious diseases specifically of bacterial origin. In order to reduce the risk and spread of bacterial antibiotic resistance, various new drugs have been searched and introduced in the biomedical science. In this reference, bacteriocin could have been an important alternative for the control of certain infectious agents. The present study was carried out to check the effect of bacteriocin produced from Enterococcus faecium on multidrug resistant bacterial isolates. The isolates of Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, were isolated from different clinical specimens and were screened for multidrug resistance by the standard Kirby-Bauer disk diffusion method. Bacteriocin was produced from Enterococcus faecium during growth in MRS broth at 37°C and was checked for antibacterial activity against above mentioned resistant bacterial isolates by agar well diffusion method. All the clinical isolates were confirmed to be multi drug resistant. The bacteriocin proved to be active against a narrow range of gram positive bacteria i.e. isolates of Staphylococcus aureus and it showed reduced activity against; isolates of Pseudomonas aeruginosa and Escherichia coli.

Background: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are major public health problems, especially in Sub-Saharan Africa including Ethiopia. So, updated information on TB-HIV co-infection might be important for the planning, resource allocation, prevention and control activities. Objective: To determine the TB-HIV co-infection and possible associated factors among patients attended TB clinic in five years (2008-2013) at a referral Hospital in Northwest Ethiopia. Methods: A retrospective study was conducted among 717 TB patients who are registered at DOTs clinic of Debre Markos referral hospital. Socio-demographic and clinical data of the study participants were collected from the TB log from the DOTS clinic. Data were entered and analyzed using SPSS version 16 software. Results: The prevalence of TB-HIV co-infection was 44% (321/717). The trend of co-infection was decreased from 2008/9 179 (49.2%) to 2012/13 29 (44.6%). Types of TB and age group were significantly associated with TB-HIV co-infection. Conclusion: The prevalence of TB-HIV co-infection was high. Therefore, actions targeting (health education and early case detection) on those predictors are necessary to effectively reduce TB-HIV co-infection and strengthen the collaborative activities.

Introduction: Assessing the microbiological and physico-chemical quality of drinking water sources is important to protect public health. Little is known about the microbiological and physico-chemical quality of drinking water in North Gondar Zone. Therefore, this study was aimed to assess the microbiological and physico-chemical quality of drinking water sources in North Gondar Zone, Northwest Ethiopia. Methods: A cross-sectional study was conducted from April-May 2014 in seven districts (Chilga, Debark, Dabat, Dembia, Gondar Town, Gondar Zuria and Wogera) in North Gondar. The physico-chemical and microbiological quality of 71 drinking water samples were determined following the standard procedure. Turbidity, pH, and temperature were measured using turbidity meter, pH meter and thermometer respectively. Arsenic, chlorine, Cr6+, NO2, NO3 and residual chlorine were determined by the colorimetric methods and rapid kits using DPM apparatus (Kyoritsu chemical-check Lab., Corp. Japan). Coliforms and Vibrio parahemolyticus were tested by rapid microbiological test strips (Sankori coliform and SankoriVibrio parahaemolyticus) following appropriate standard procedure. Consumers assessment was also conducted using questionnaire about the water sources. Data were entered and analyzed using SPSS version 20 software. Results: The physico-chemical and microbiological quality of 71 water samples (tap n=29, spring n=15 and well n=27) were assessed. The mean turbidity of water samples was 19.35 + 5.75SD nephlometric turbidity unit (NTU), temperature 21.34+3.68 oc, pH 6.88+0.6, nitrate 10.02 + 8.72 mg/l, nitrite 0.33+0.64 mg/l, residual chlorine 0.01 + 0.06 mg/l, arsenic 0.2+0.00 mg/l and chromium 0.51+0.01 mg/l. Almost all samples were complying with the WHO acceptable range for nitrate arsenic and chromium among the physico-chemical parameters. However, turbidity was found to be unacceptably high in 21 (29.6%) samples, pH was unacceptably low in 26 (36.6%) of the samples and residual chlorine was unacceptably low in 69 (97.2%) of the samples. The majority of samples (n=46; 64.8%) had coliforms and 12 (16.9%) had Vibrio parahemolyticus. Conclusion: Most of the physical and chemical parameters measured were within the recommended range except turbidity and residual chlorine. However, the majorities of drinking water samples were found to be contaminated and are potential risk to public health. Therefore, regular quality monitoring and frequent water treatment in the study area is mandatory.