First report of cutaneous leishmaniasis caused by Leishmania donovani in Ethiopia.

BACKGROUND: Leishmaniasis is a common neglected tropical disease in Ethiopia. Visceral leishmaniasis (VL) caused by Leishmania donovani presents in the lowlands, while cutaneous leishmaniasis (CL) affects people living in the highlands. Although CL is described as being caused by Leishmania aethiopica, there is also evidence of L. tropica and L. major isolated from a patient, sand flies and potential reservoirs. Information on species causing CL in Ethiopia is patchy, and no nation-wide study has ever been done. Understanding which species are causing CL in Ethiopia can have important implications for patient management and disease prevention. METHODS: We analyzed stored routine samples and biobanked DNA isolates from previously conducted studies of CL patients from different centers in the north, center and south of Ethiopia. Species typing was performed using ITS-1 PCR with high-resolution melt (HRM) analysis, followed by HSP70 amplicon sequencing on a selection of the samples. Additionally, sociodemographic, clinical and laboratory data of patients were analyzed. RESULTS: Of the 226 CL samples collected, the Leishmania species could be determined for 105 (45.5%). Leishmania aethiopica was identified in 101 (96.2%) samples from across the country. In four samples originating from Amhara region, northwestern Ethiopia, L. donovani was identified by ITS-1 HRM PCR, of which two were confirmed with HSP70 sequences. While none of these four patients had symptoms of VL, two originated from known VL endemic areas. CONCLUSIONS: The majority of CL was caused by L. aethiopica, but CL due to L. tropica and L. major cannot be ruled out. Our study is the first to our knowledge to demonstrate CL patients caused by L. donovani in Ethiopia. This should spark future research to investigate where, how and to which extent such transmission takes place, how it differs genetically from L. donovani causing VL and whether such patients can be diagnosed and treated successfully with the currently available tools and drugs.

Sepsis: emerging pathogens and antimicrobial resistance in Ethiopian referral hospitals.

BACKGROUND: Sepsis due to multidrug resistant (MDR) bacteria is a growing public health problem mainly in low-income countries. METHODS: A multicenter study was conducted between October 2019 and September 2020 at four hospitals located in central (Tikur Anbessa and Yekatit 12), southern (Hawassa) and northern (Dessie) parts of Ethiopia. A total of 1416 patients clinically investigated for sepsis were enrolled. The number of patients from Tikur Anbessa, Yekatit 12, Dessie and Hawassa hospital was 501, 298, 301 and 316, respectively. At each study site, blood culture was performed from all patients and positive cultures were characterized by their colony characteristics, gram stain and conventional biochemical tests. Each bacterial species was confirmed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI TOF). Antimicrobial resistance pattern of bacteria was determined by disc diffusion. Logistic regression analysis was used to assess associations of dependent and independent variables. A p-value < 0.05 was considered as statistically significant. The data was analyzed using SPSS version 25. RESULTS: Among 1416 blood cultures performed, 40.6% yielded growth. Among these, 27.2%, 0.3% and 13.1%, were positive for pathogenic bacteria, yeast cells and possible contaminants respectively. Klebsiella pneumoniae (26.1%), Klebsiella variicola (18.1%) and E. coli (12.4%) were the most frequent. Most K. variicola were detected at Dessie (61%) and Hawassa (36.4%). Almost all Pantoea dispersa (95.2%) were isolated at Dessie. Rare isolates (0.5% or 0.2% each) included Leclercia adecarboxylata, Raoultella ornithinolytica, Stenotrophomonas maltophilia, Achromobacter xylosoxidans, Burkholderia cepacia, Kosakonia cowanii and Lelliottia amnigena. Enterobacteriaceae most often showed resistance to ampicillin (96.2%), ceftriaxone (78.3%), cefotaxime (78%), cefuroxime (78%) and ceftazidime (76.4%). MDR frequency of Enterobacteriaceae at Hawassa, Tikur Anbessa, Yekatit 12 and Dessie hospital was 95.1%, 93.2%, 87.3% and 67.7%, respectively. Carbapenem resistance was detected in 17.1% of K. pneumoniae (n = 111), 27.7% of E. cloacae (n = 22) and 58.8% of Acinetobacter baumannii (n = 34). CONCLUSION: Diverse and emerging gram-negative bacterial etiologies of sepsis were identified. High multidrug resistance frequency was detected. Both on sepsis etiology types and MDR frequencies, substantial variation between hospitals was determined. Strategies to control MDR should be adapted to specific hospitals. Standard bacteriological services capable of monitoring emerging drug-resistant sepsis etiologies are essential for effective antimicrobial stewardship.

HIGH PREVALENCE OF ATRIAL FIBRILLATION IN STROKE PATIENTS ADMITTED TO UNIVERSITY OF GONDAR HOSPITAL, NORTHWEST ETHIOPIA.

Introduction: Even though atrial fibrillation is a common risk factor of stroke which contributes to poor outcome, data concerning this association is scarce in African countries. This study assessed the prevalence of confirmed atrial fibrillation and its effect on outcome in stroke patients admitted to University of Gondar Hospital. Methods: Hospital based cross-sectional study by record analysis was done from December 2014 to February 2015. All adult stroke patients with documented head CT scan and ECG results admitted to university of Gondar hospital during June 2010 to May 2013 were included. Relevant data including sociodemographics, type of stroke, and presence of atrial fibrillation was collected from patient charts using a data extraction form. Results: A total of 94 patients with mean age of 67.4±12.4 years and Female to male ratio of 1.13:1 were analyzed. The prevalence of AF was 28.7%. It occurred in 34% and 14% of ischemic and hemorrhagic strokes respectively. The in hospital case fatality of stroke associated with and without atrial fibrillation was 22.2% and 8% respectively while the rate of improvement at discharge was 34% and 68% respectively. Atrial fibrillation was associated with a low rate of improvement at discharge (OR= 0.28 CI: 0.1-0.78). Conclusion: Atrial fibrillation is common in stroke patients in our hospital, especially in the elderly population. It is associated with low rate of improvement at discharge. Appropriate screening and treatment of atrial fibrillation is invaluable for the primary and secondary prevention of stroke.