Laboratory indices of hospitalized sickle cell disease patients, prevalence and antimicrobial susceptibility of pathogenic bacterial isolates at MRCG ward in the Gambia.

BACKGROUND: The aim of this study was to determine the prevalence of invasive bacterial infections and their antimicrobial resistance patterns in sickle cell disease (SCD) patients admitted at the Medical Research Council the Gambia (MRCG) Ward in the era of PCV and Hib vaccination in the Gambia. METHODS AND RESULTS: This study was conducted in the clinical laboratory department of MRCG. We retrospectively generated haematological, and blood culture data from our electronic medical records from 2015 to 2022 of SCD patients admitted to MRCG Ward. Of 380 SCD patients, blood culture was requested only for 159. Of the 159 admitted SCD, 11 patients had qualified positive blood cultures. Five different types of bacterial pathogens were isolated from these positive blood cultures: 4 Staphylococcus aureus, 3 Streptococcus pneumoniae, 2 Salmonella species, 1 Enterococcus species, and 1 Shigella boydii. No episode of bacteremia caused by Haemophilus influenzae type b was identified. The molecular serotyping of the Streptococcus pneumoniae isolates revealed non-vaccine serotypes 10 A, 12 F and 12 F. Penicillin resistance was recorded in two of the three Streptococcus pneumoniae. The Staphylococcus aureus isolates were penicillin resistant but cefoxitin sensitive, hence no methicillin (oxacillin) resistant Staphylococcus aureus was reported. Generally, the isolated pathogens were all sensitive to chloramphenicol, and vancomycin. The haematological indices were not significantly varied between SCD patients with and without microbiologically confirmed bacterial infection. CONCLUSION: Streptococcus pneumoniae and Staphylococcus aureus were the most common cause of bacteremia in these admitted SCD patients. The presence of non-typhoidal Salmonella and Shigella infection coupled with penicillin resistance should be considered during penicillin prophylaxis and empirical treatment regimens for SCD patients and future SCD management policies in the Gambia. The haematological parameters may not be reliable biomarkers in differentiating bacterial from non-bacterial infections in SCD patients.

Plasmodium malariae structure and genetic diversity in sub-Saharan Africa determined from microsatellite variants and linked SNPs in orthologues of antimalarial resistance genes.

Plasmodium malariae, a neglected human malaria parasite, contributes up to 10% of malaria infections in sub-Saharan Africa (sSA). Though P. malariae infection is considered clinically benign, it presents mostly as coinfections with the dominant P. falciparum. Completion of its reference genome has paved the way to further understand its biology and interactions with the human host, including responses to antimalarial interventions. We characterized 75 P. malariae isolates from seven endemic countries in sSA using highly divergent microsatellites. The P. malariae infections were highly diverse and five subpopulations from three ancestries (independent of origin of isolates) were determined. Sequences of 11 orthologous antimalarial resistance genes, identified low frequency single nucleotide polymorphisms (SNPs), strong linkage disequilibrium between loci that may be due to antimalarial drug selection. At least three sub-populations were detectable from a subset of denoised SNP data from mostly the mitochondrial cytochrome b coding region. This evidence of diversity and selection calls for including P. malariae in malaria genomic surveillance towards improved tools and strategies for malaria elimination.

Genome-wide SNP analysis of Plasmodium falciparum shows differentiation at drug-resistance-associated loci among malaria transmission settings in southern Mali.

Plasmodium falciparum malaria cases in Africa represent over 90% of the global burden with Mali being amongst the 11 highest burden countries that account for 70% of this annual incidence. The persistence of P. falciparum despite massive global interventions is because of its genetic diversity that drives its ability to adapt to environmental changes, develop resistance to drugs, and evade the host immune system. Knowledge on P. falciparum genetic diversity across populations and intervention landscape is thus critical for the implementation of new strategies to eliminate malaria. This study assessed genetic variation with 12,177 high-quality SNPs from 830 Malian P. falciparum isolates collected between 2007 and 2017 from seven locations. The complexity of infections remained high, varied between sites, and showed a trend toward overall decreasing complexity over the decade. Though there was no significant substructure, allele frequencies varied geographically, partly driven by temporal variance in sampling, particularly for drug resistance and antigen loci. Thirty-two mutations in known drug resistance markers (pfcrt, pfdhps, pfdhfr, pfmdr1, pfmdr2, and pfk13) attained a frequency of at least 2% in the populations. SNPs within and around the major markers of resistance to quinolines (pfmdr1 and pfcrt) and antifolates (pfdhfr and pfdhps) varied temporally and geographically, with strong linkage disequilibrium and signatures of directional selection in the genome. These geo-temporal populations also differentiated at alleles in immune-related loci, including, protein E140, pfsurfin8, pfclag8, and pfceltos, as well as pftrap, which showed signatures of haplotype differentiation between populations. Several regions across the genomes, including five known drug resistance loci, showed signatures of differential positive selection. These results suggest that drugs and immune pressure are dominant selective forces against P. falciparum in Mali, but their effect on the parasite genome varies temporally and spatially. Interventions interacting with these genomic variants need to be routinely evaluated as malaria elimination strategies are implemented.

Plasmodium falciparum merozoite invasion ligands, linked antimalarial resistance loci and ex vivo responses to antimalarials in The Gambia.

BACKGROUND: Artemether/lumefantrine is the most commonly used artemisinin-based combination treatment (ACT) for malaria in sub-Saharan Africa. Drug resistance to ACT components is a major threat to malaria elimination efforts. Therefore, rigorous monitoring of drug efficacy is required for adequate management of malaria and to sustain the effectiveness of ACTs. OBJECTIVES: This study identified and described genomic loci that correlate with differences in ex vivo responses of natural Plasmodium falciparum isolates from The Gambia to antimalarial drugs. METHODS: Natural P. falciparum isolates from The Gambia were assayed for IC50 responses to four antimalarial drugs (artemether, dihydroartemisinin, amodiaquine and lumefantrine). Genome-wide SNPs from 56 of these P. falciparum isolates were applied to mixed-model regression and network analyses to determine linked loci correlating with drug responses. Genomic regions of shared haplotypes and positive selection within and between Gambian and Cambodian P. falciparum isolates were mapped by identity-by-descent (IBD) analysis of 209 genomes. RESULTS: SNPs in 71 genes, mostly involved in stress and drug resistance mechanisms correlated with drug responses. Additionally, erythrocyte invasion and permeability loci, including merozoite surface proteins (Pfdblmsp, Pfsurfin), and high-molecular-weight rhoptry protein 2 (Pfrhops2) were correlated with responses to multiple drugs. Haplotypes of pfdblmsp2 and known drug resistance loci (pfaat1, pfcrt and pfdhfr) from The Gambia showed high IBD with those from Cambodia, indicating co-ancestry, with significant linkage disequilibrium between their alleles. CONCLUSIONS: Multiple linked genic loci correlating with drug response phenotypes suggest a genomic backbone may be under selection by antimalarials. This calls for further analysis of molecular pathways to drug resistance in African P. falciparum.

Oral insulin delivery, the challenge to increase insulin bioavailability: Influence of surface charge in nanoparticle system.

Oral administration of insulin increases patient comfort and could improve glycemic control thanks to the hepatic first passage. However, challenges remain. The current approach uses poly (d, lactic-co-glycolic) acid (PLGA) nanoparticles (NPs), an effective drug carrier system with a long acting profile. However, this system presents a bioavailability of less than 20% for insulin encapsulation. In this context, physico-chemical parameters like surface charge could play a critical role in NP uptake by the intestinal barrier. Therefore, we developed a simple method to modulate NP surface charge to test its impact on uptake in vitro and finally on NP efficiency in vivo. Various NPs were prepared in the presence (+) or absence (-) of polyvinyl alcohol (PVA), sodium dodecyl sulfate (SDS), and/or coated with chitosan chloride. In vitro internalization was tested using epithelial culture of Caco-2 or using a co-culture (Caco-2/RevHT29MTX) by flow cytometry. NPs were then administered by oral route using a pharmaceutical complex vector (100 or 250 UI/kg) in a diabetic rat model. SDS-NPs (-42 ±â€¯2 mV) were more negatively charged than -PVA-NPs (-22 ±â€¯1 mV) and chitosan-coated NPs were highly positively charged (56 ±â€¯2 mV) compared to +PVA particles (-2 ±â€¯1 mV), which were uncharged. In the Caco-2 model, NP internalization was significantly improved by using negatively charged NPs (SDS NPs) compared to using classical NPs (+PVA NPs) and chitosan-coated NPs. Finally, the efficacy of insulin SDS-NPs was demonstrated in vivo (100 or 250 UI insulin/kg) with a reduction of blood glucose levels in diabetic rats. Formulation of negatively charged NPs represents a promising approach to improve NP uptake and insulin bioavailability for oral delivery.

Acetonyltri-phenyl-phospho-nium 2,3,5-tri-phenyl-tetra-zolium tetra-chlorido-cuprate(II).

The title compound, (C21H20OP)(C19H15N4)[CuCl4], was obtained by reacting CuCl2·2H2O with a mixture of one equivalent of acetonyltri-phenyl-phospho-nium chloride and one equivalent of 2,3,5-tri-phenyl-tetra-zolium chloride in aceto-nitrile. In the structure, the Cu centre in the dianion is bonded to four chloride ligands and adopts a distorted tetra-hedral geometry. The phospho-nium cation likewise adopts the expected tetra-hedral geometry. The tetra-zolium ring forms dihedral angles of 77.68 (10), 26.85 (11) and 66.48 (10)° with the planes of the benzene rings of the substituent groups. In the crystal, weak C-H⋯Cl hydrogen-bonding inter-actions involving both cations and the anion give rise to a three-dimensional supra-molecular structure.

Crystal structure of 2-methyl-1H-imidazol-3-ium hydrogen oxalate dihydrate.

Single crystals of the title mol-ecular salt, C4H7N2 (+)·HC2O4 (-)·2H2O, were isolated from the reaction of 2-methyl-1H-imidazole and oxalic acid in a 1:1 molar ratio in water. In the crystal, the cations and anions are positioned alternately along an infinite [010] ribbon and linked together through bifurcated N-H⋯(O,O) hydrogen bonds. The water mol-ecules of crystallization link the chains into (10-1) bilayers, with the methyl groups of the cations organized in an isotactic manner.

Crystal structures of the two salts 2-methyl-1H-imidazol-3-ium nitrate-2-methyl-1H-imidazole (1/1) and 2-methyl-1H-imidazol-3-ium nitrate.

The title salts, C4H7N2 (+)·NO3 (-)·C4H6N2, (I), and C4H7N2 (+)·NO3 (-), (II), were obtained from solutions containing 2-methyl-imidazole and nitric acid in different concentrations. In the crystal structure of salt (I), one of the -NH H atoms of the imidazole ring shows half-occupancy, hence only every second mol-ecule is in its cationic form. The nitrate anion in this structure lies on a twofold rotation axis. The neutral 2-methyl-imidazole mol-ecule and the 2-methyl-1H-imidazol-3-ium cation inter-act through N-H⋯N hydrogen bonds to form [(C4H6N2)⋯(C4H7N2)(+)] pairs. These pairs are linked with two nitrate anions on both sides through bifurcated N-H⋯(O,O) hydrogen bonds into chains running parallel to [001]. In the crystal structure of salt (II), the C4H7N2 (+) cation and the NO3 (-) anion are both located on a mirror plane, leading to a statistical disorder of the methyl H atoms. The cations and anions again inter-act through bifurcated N-H⋯(O,O) hydrogen bonds, giving rise to the formation of chains consisting of alternating anions and cations parallel to [100].

Crystal structure of bis-(2-methyl-1H-imidazol-3-ium) µ-oxalato-bis-[n-butyl-tri-chlorido-stannate(IV)].

The Sn(IV) atom in the centrosymmetric anion of the title salt, (C4H7N2)2[Sn2(C4H9)2(C2O4)Cl6], is coordinated in a distorted octa-hedral mode by two O atoms of a bridging oxalate moiety, three Cl atoms and a C atom of an n-butyl group. The latter is disordered over two sets of sites in a 0.66:0.33 occupancy ratio. N-H⋯O and N-H⋯Cl hydrogen bonds involving the 2-methyl-imidazolium cation and neighbouring anions result in the formation of chains extending parallel to [001].

Crystal structure of N-[(methyl-sulfan-yl)carbon-yl]urea.

The almost planar (r.m.s. deviation = 0.055 Å) title compound, (MeS)C(O)NHC(O)NH2, was formed during an attempted crystallization of dimethyl cyano-carbonimidodi-thio-ate with CrO2Cl2; an unexpected redox reaction converted the cyano-carbonimido moiety to a urea group and removed one methyl-thiol group. In the crystal, hydrogen-bonding inter-actions from the amide and amido N-H groups to carbonyl O atoms of neighbouring mol-ecules result in [010] ribbon-like chains.

Crystal structure of bis-(2-methyl-1H-imidazol-3-ium) di-hydroxidobis(oxalato-κ(2) O (1),O (2))stannate(IV) monohydrate.

In the structure of the hydrated title salt, (C4H7N2)2[Sn(C2O4)2(OH)2]·H2O, the asymmetric unit comprises one stannate(IV) dianion, two organic cations and one water mol-ecule of crystallization. The [Sn(C2O4)2(OH)2](2-) dianion consists of an Sn(IV) atom chelated by two oxalate anions and coordinated by two OH(-) ligands in a cis octa-hedral arrangement. Neighbouring anions are connected through O-H⋯O hydrogen bonds between hydroxide groups and non-coordinating oxalate O atoms into layers expanding parallel to (100). In addition, cations and anions are linked through N-H⋯O hydrogen bonds, and the water mol-ecule bridges two anions with two O-H⋯O hydrogen bonds and is also the acceptor of an N-H⋯O hydrogen bond with one of the cations. Weak C-H⋯O hydrogen bonds are also observed. The intricate hydrogen bonding leads to the formation of a three-dimensional network.

Crystal structure of di-chlorido-bis-(dimethyl N-cyano-dithio-imino-carbonate)zinc.

The Zn(II) atom in the title complex, [ZnCl2(C4H6N2S2)2], is coordinated in a distorted tetra-hedral manner by two Cl atoms and two terminal N atoms of two dimethyl N-cyano-dithio-imino-carbonate ligands. In the crystal, the complex mol-ecules are connected through C-H⋯Cl hydrogen bonds and Cl⋯S contacts, leading to a two-dimensional structure extending parallel to the ab plane.

Crystal structure of di-chlorido-bis-(dimethyl N-cyano-dithio-imino-carbonate)cobalt(II).

The structure of the mononuclear title complex, [{(H3CS)2C=NC  N}2CoCl2], consists of a Co(II) atom coordinated in a distorted tetra-hedral manner by two Cl(-) ligands and the terminal N atoms of two dimethyl N-cyano-dithio-imino-carbonate ligands. The two organic ligands are almost coplanar, with a dihedral angle of 5.99 (6)° between their least-squares planes. The crystal packing features pairs of inversion-related complexes that are held together through C-H⋯Cl and C-H⋯S inter-actions and π-π stacking [centroid-to-centroid distance = 3.515 (su?) Å]. Additional C-H⋯Cl and C-H⋯S inter-actions, as well as Cl⋯S contacts < 3.6 Å, consolidate the crystal packing.

Crystal structure of bis-(2-methyl-1H-imidazol-3-ium) tetra-chlorido-cobaltate(II).

The asymmetric unit of the title compound, (C4H7N2)2[CoCl4], consists of two 2-methyl-imidazolium cations and one tetra-hedral [CoCl4](2-) anion. The anions and cations inter-act through N-H⋯Cl hydrogen bonds to define layers with a stacking direction along [100]. Besides van der Waals forces, weak C-H⋯Cl inter-actions between these layers stabilize the crystal packing.

Crystal structure of 2-methyl-1H-imidazol-3-ium aqua-tri-chlorido-(oxalato-κ(2) O,O')stannate(IV).

The tin(IV) atom in the complex anion of the title salt, (C4H7N2)[Sn(C2O4)Cl3(H2O)], is in a distorted octa-hedral coordination environment defined by three chlorido ligands, an oxygen atom from a water mol-ecule and two oxygen atoms from a chelating oxalate anion. The organic cation is linked through a bifurcated N-H⋯O hydrogen bond to the free oxygen atoms of the oxalate ligand of the complex [Sn(H2O)Cl3(C2O4)](-) anion. Neighbouring stannate(IV) anions are linked through O-H⋯O hydrogen bonds involving the water mol-ecule and the two non-coordinating oxalate oxygen atoms. In combination with additional N-H⋯Cl hydrogen bonds between cations and anions, a three-dimensional network is spanned.

Crystal structure of bis-(acetonyltri-phenyl-phospho-nium) tetra-chlorido-cobaltate(II).

The complex title salt, (C21H20OP)2[CoCl4], is the reaction product of CoCl2 with acetonyltri-phenyl-phospho-nium chloride in aceto-nitrile. In the anion, the Co(II) atom exhibits a typical tetra-hedral environment, with Co-Cl distances ranging from 2.2721 (6) to 2.2901 (6) Å, and with Cl-Co-Cl angles ranging from 106.12 (2) to 112.24 (2)°. The two phospho-nium cations likewise show the expected tetra-hedral configuration, with P-C distances ranging from 1.785 (2) to 1.8059 (18) Šand C-P-C angles ranging from 106.98 (8) to 112.85 (15)°. The mol-ecules inter-act in the lattice mainly through Coulombic and van der Waals forces because there is no particular polarity to the charges carried by the cations or anion. In the crystal, the cations and anions are arranged in sheets parallel to (001).