Microbiological assessment reveals that Salmonella, Shigella and Campylobacter infections are widespread in HIV infected and uninfected patients with diarrhea in Mozambique.

Diarrhea is an important cause of hospitalizations in Mozambique. However, little attention has been paid to the impact HIV infection on the prevalence or clinical manifestations of enteric bacterial infections. This study aimed to determine the prevalence of Salmonella spp., Shigella spp. and Campylobacter spp. in HIV-infected and HIV-uninfected patients with diarrhea, identify risk factors for infection, and explore the association between HIV status, viral load, and bacterial prevalence. We conducted a case-control study at the Centro de Saúde de Mavalane and Centro de Saúde 1° de Maio in Maputo, Mozambique, from November 2021 to May 2022. We recruited 300 patients, including 150 HIV-infected (cases) and 150 HIV-uninfected patients (controls), aged between 0-88 years, presenting with diarrhea. Stool samples were collected for bacterial isolation through culture, and for each HIV-infected patient, 4 ml of venous blood were obtained for viral load detection through PCR. A total of 129 patients (43.0%) had at least one bacterial infection. The prevalence of Salmonella spp., Shigella spp. and Campylobacter spp. was 33.0% (n = 99), 15.0% (n = 45) and 4.3% (n = 13), respectively. The prevalence of any bacterial infection did not differ significantly between HIV-infected (45.3%, n = 68) and HIV-uninfected patients (40.7%, = 61) (p = 0.414). Overall, having 2-3 symptoms of enteric disease (p = 0.008) and a basic education (p = 0.030) were factors associated with bacterial infection. Of the 148 patients for whom HIV-1 RNA levels were available, 115 had copy numbers ≤ 75. Another 13 had levels between 76 and 1,000 and the remaining 20 had an average of 327,218.45 copies/ml. Bivariate logistic regression found that Shigella spp. were associated with HIV (p = 0.038), although no association was found in the multivariate analysis. Enteric infections are common in both HIV-infected and -uninfected patients. Low schooling influences the occurrence of enteric infections, which highlights the need to raise awareness about their prevention.

Ethnobotanical study of plants used by the traditional healers to treat malaria in Mogovolas district, northern Mozambique.

INTRODUCTION: Malaria is an important parasitic disease that affects mostly the African continent. Traditional medicine is very important in Mozambique and traditional healers play a key role in the primary health care services, particularly in rural areas. We aim to report the results of an ethnobotanical survey undertaken in Mogovolas district, northern region of Mozambique. We recorded and identified the medicinal plants used by traditional healers for treatment of malaria, as well as the mode of preparation and administration. METHODS: The study was conducted in 14 villages from Mogovolas between June and August 2015. Sixteen traditional healers were interviewed using semi-structured questionnaires. Under their guidance, we collected medicinal plants and prepared herbarium specimens that were sent and kept at Eduardo Mondlane University Herbarium for scientific identification. We searched for information on the in vitro and in vivo studies of the cited plants for antiplasmodial activity. RESULTS: Traditional healers from Mogovolas district reported the use of 37 plants to treat malaria, belonging to 22 families. The most used species are Ochna kirkii Oliv. (5 citations), Ehretia amoena Klotzsch and Pteleopsis myrtifolia (M.A.Lawson) Engl. & Diels (both with 3 citations). These plants belong to Ochnaceae, Boraginaceae and Combretaceae families, respectively. The herbal remedies are prepared using leaves (22/37), roots (18/37), stem barks (16/37) and stems (3/37). The administration of the herbal remedies was made essentially by oral route and bathing. CONCLUSION: The ethnobotanical data resulted from this study can be the starting point for further chemical and pharmacological studies aiming to identify medicinal species with antimalarial activity, thus, open the insights for the discovery of new antimalarial substances, as well as better integration of the traditional medicine into the national health systems, particularly in developing countries, as the health system coverage is limited.

A Systematic Review of In Vitro Activity of Medicinal Plants from Sub-Saharan Africa against Campylobacter spp.

INTRODUCTION: Campylobacter spp. are zoonotic bacteria that cause gastroenteritis in humans and may cause extraintestinal infections such as Guillain-Barré syndrome, reactive arthritis, and bacteremia. Resistance to antibiotics is an increasing concern in the Sub-Saharan Africa; thus, search for alternatives such as plant-based active ingredients is important in order to develop new drugs. OBJECTIVES: To present a systematic review of in vitro and in vivo studies of the antibacterial activity of medicinal plants from Sub-Saharan Africa against Campylobacter spp. Methodology. Studies published until March 2020 on medicinal plants used against Campylobacter spp. from each country of Sub-Saharan Africa were searched on PubMed, Science Direct, AJOL, and Google Scholar. Articles were selected based on the existence of information regarding in vitro and in vivo activity of medicinal plants against Campylobacter spp. RESULTS: A total of 47 medicinal plants belonging to 28 families were studied for in vitro activity against Campylobacter spp. No plant was studied in vivo. Plants from Fabaceae family were the most commonly studied. The plants with the strongest antimicrobial activities were Cryptolepis sanguinolenta and Terminalia macroptera. The root extracts from these plants were effective, and both had a minimal inhibitory concentration (MIC) of 25 µg/ml. Seven pure compounds were isolated and analyzed for activity against Campylobacter spp. The compound cryptolepine from C. sanguinolenta was the most effective with MIC values ranging between 6.25 and 25 µg/ml. CONCLUSION: Several native plants from the Sub-Saharan Africa region were studied for in vitro activity against Campylobacter spp. Some plants seemed very effective against the bacteria. Chemical compounds from three plants have been isolated and analyzed, but further studies are needed in order to produce new and effective drugs.

Epidemiology and antimicrobial resistance of Campylobacter spp. in animals in Sub-Saharan Africa: A systematic review.

INTRODUCTION: Low sanitary conditions characterize the rural and urban households in Sub-Saharan African region. Those environmental conditions propitiate the transmission of bacterial infections between animals and humans. Campylobacter spp. is a zoonotic bacterium and cause of human gastroenteritis worldwide, whose main symptom is diarrhea. It is normally found in the digestive tract of many farm animals as a commensal but some species cause diseases in animals. It is important to understand the occurrence of these bacteria in animals, as they may also play a role in transmission to humans. The main objective of this review was to describe the prevalence of Campylobacter in animals in Sub-Saharan Africa. We also report findings on antibiotic resistance. METHODS: We followed PRISMA guidelines to find studies about occurrence of Campylobacter spp. in animals in all countries from Sub-Saharan Africa. PubMed, Cochrane Library, CINAHL, African Index Medicus, African Journals Online, Google Scholar and Science Direct were searched for studies published between 2000 and 2019. RESULTS: We found 70 studies that described occurrence of Campylobacter spp. in animals in 18 out of 53 countries of Sub-Saharan Africa. Campylobacter jejuni and C. coli were the predominant species isolated. The majority of studies were found in Western Africa. Middle Africa had the lowest amount of data. Most records presented data from Nigeria (n = 25), South Africa (n = 14) and Tanzania (n = 11). Cattle and chickens appear to be important hosts and may be playing an important role in transmitting to humans. Most Campylobacter isolates were resistant to erythromycin (44%), ampicillin (39%), tetracycline (33%), nalidixic acid (31%) and ciprofloxacin (30%). CONCLUSION: Several studies about Campylobacter spp. in animals have been published in the last 19 years but information on the epidemiology of campylobacteriosis is scarce in most Sub-Saharan African countries. Antibiotic resistance is an increasing concern in many countries. Measures should be taken to prevent infection by this pathogen in the region and to control antibiotic resistance.