An Epidemiologic Review of Enteropathogens in Gaborone, Botswana: Shifting Patterns of Resistance in an HIV Endemic Region
Identifieur interne : 000C93 ( Ncbi/Curation ); précédent : 000C92; suivant : 000C94An Epidemiologic Review of Enteropathogens in Gaborone, Botswana: Shifting Patterns of Resistance in an HIV Endemic Region
Auteurs : Jack S. Rowe [Botswana, États-Unis] ; Samir S. Shah [États-Unis] ; Stephen Motlhagodi [Botswana] ; Margaret Bafana [Botswana] ; Ephraim Tawanana [Botswana] ; Hong T. Truong [Botswana] ; Sarah M. Wood [États-Unis] ; Nicola M. Zetola [Botswana] ; Andrew P. Steenhoff [Botswana, États-Unis]Source :
- PLoS ONE [ 1932-6203 ] ; 2010.
Abstract
The epidemiology of diarrheal disease in Botswana, an HIV endemic region, is largely unknown. Our primary objective was to characterize the prevalent bacterial and parasitic enteropathogens in Gaborone, Botswana. Secondary objectives included determining corresponding antimicrobial resistance patterns and the value of stool white and red blood cells for predicting bacterial and parasitic enteropathogens.
A retrospective cross-sectional study examined laboratory records of stool
specimens analyzed by the Botswana National Health Laboratory in Gaborone,
Botswana from February 2003 through July 2008. In 4485 specimens the median
subject age was 23 [interquartile range 1.6–34]
years. Overall, 14.4% (644 of 4485) of samples yielded a
pathogen. Bacteria alone were isolated in 8.2% (367 of 4485),
parasites alone in 5.6% (253 of 4485) and both in 0.5%
(24 of 4485) of samples. The most common bacterial pathogens were
Most gastroenteritis stools were culture and microscopy negative suggesting
that viral pathogens were the majority etiologic agents in this Botswana
cohort.
Url:
DOI: 10.1371/journal.pone.0010924
PubMed: 20543877
PubMed Central: 2881529
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PMC:2881529Le document en format XML
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Shifting Patterns of Resistance in an HIV Endemic Region</title>
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Shifting Patterns of Resistance in an HIV Endemic Region</title>
<author><name sortKey="Rowe, Jack S" sort="Rowe, Jack S" uniqKey="Rowe J" first="Jack S." last="Rowe">Jack S. Rowe</name>
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<author><name sortKey="Motlhagodi, Stephen" sort="Motlhagodi, Stephen" uniqKey="Motlhagodi S" first="Stephen" last="Motlhagodi">Stephen Motlhagodi</name>
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<author><name sortKey="Bafana, Margaret" sort="Bafana, Margaret" uniqKey="Bafana M" first="Margaret" last="Bafana">Margaret Bafana</name>
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<country xml:lang="fr">Botswana</country>
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<wicri:regionArea>Princess Marina Hospital, Gaborone</wicri:regionArea>
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<author><name sortKey="Tawanana, Ephraim" sort="Tawanana, Ephraim" uniqKey="Tawanana E" first="Ephraim" last="Tawanana">Ephraim Tawanana</name>
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</nlm:aff>
<country xml:lang="fr">Botswana</country>
<wicri:regionArea>Botswana National Health Laboratory, Gaborone</wicri:regionArea>
<wicri:noRegion>Gaborone</wicri:noRegion>
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<affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Princess Marina Hospital, Gaborone, Botswana</addr-line>
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<country xml:lang="fr">Botswana</country>
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<author><name sortKey="Truong, Hong T" sort="Truong, Hong T" uniqKey="Truong H" first="Hong T." last="Truong">Hong T. Truong</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Botswana-UPenn Partnership, Gaborone, Botswana</addr-line>
</nlm:aff>
<country xml:lang="fr">Botswana</country>
<wicri:regionArea>Botswana-UPenn Partnership, Gaborone</wicri:regionArea>
<wicri:noRegion>Gaborone</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Wood, Sarah M" sort="Wood, Sarah M" uniqKey="Wood S" first="Sarah M." last="Wood">Sarah M. Wood</name>
<affiliation wicri:level="2"><nlm:aff id="aff5"><addr-line>The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania</wicri:regionArea>
<placeName><region type="state">Pennsylvanie</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Zetola, Nicola M" sort="Zetola, Nicola M" uniqKey="Zetola N" first="Nicola M." last="Zetola">Nicola M. Zetola</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Botswana-UPenn Partnership, Gaborone, Botswana</addr-line>
</nlm:aff>
<country xml:lang="fr">Botswana</country>
<wicri:regionArea>Botswana-UPenn Partnership, Gaborone</wicri:regionArea>
<wicri:noRegion>Gaborone</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Princess Marina Hospital, Gaborone, Botswana</addr-line>
</nlm:aff>
<country xml:lang="fr">Botswana</country>
<wicri:regionArea>Princess Marina Hospital, Gaborone</wicri:regionArea>
<wicri:noRegion>Gaborone</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Steenhoff, Andrew P" sort="Steenhoff, Andrew P" uniqKey="Steenhoff A" first="Andrew P." last="Steenhoff">Andrew P. Steenhoff</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Botswana-UPenn Partnership, Gaborone, Botswana</addr-line>
</nlm:aff>
<country xml:lang="fr">Botswana</country>
<wicri:regionArea>Botswana-UPenn Partnership, Gaborone</wicri:regionArea>
<wicri:noRegion>Gaborone</wicri:noRegion>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania</wicri:regionArea>
<placeName><region type="state">Pennsylvanie</region>
</placeName>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Princess Marina Hospital, Gaborone, Botswana</addr-line>
</nlm:aff>
<country xml:lang="fr">Botswana</country>
<wicri:regionArea>Princess Marina Hospital, Gaborone</wicri:regionArea>
<wicri:noRegion>Gaborone</wicri:noRegion>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="aff5"><addr-line>The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania</wicri:regionArea>
<placeName><region type="state">Pennsylvanie</region>
</placeName>
</affiliation>
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</analytic>
<series><title level="j">PLoS ONE</title>
<idno type="eISSN">1932-6203</idno>
<imprint><date when="2010">2010</date>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>The epidemiology of diarrheal disease in Botswana, an HIV endemic region, is
largely unknown. Our primary objective was to characterize the prevalent
bacterial and parasitic enteropathogens in Gaborone, Botswana. Secondary
objectives included determining corresponding antimicrobial resistance
patterns and the value of stool white and red blood cells for predicting
bacterial and parasitic enteropathogens.</p>
</sec>
<sec><title>Methodology/Principal Findings</title>
<p>A retrospective cross-sectional study examined laboratory records of stool
specimens analyzed by the Botswana National Health Laboratory in Gaborone,
Botswana from February 2003 through July 2008. In 4485 specimens the median
subject age was 23 [interquartile range 1.6–34]
years. Overall, 14.4% (644 of 4485) of samples yielded a
pathogen. Bacteria alone were isolated in 8.2% (367 of 4485),
parasites alone in 5.6% (253 of 4485) and both in 0.5%
(24 of 4485) of samples. The most common bacterial pathogens were
<italic>Shigella</italic>
spp. and <italic>Salmonella</italic>
spp.,
isolated from 4.0% (180 of 4485) and 3.9% (175 of
4485) of specimens, respectively. <italic>Escherichia coli</italic>
(22 of
4485) and <italic>Campylobacter</italic>
spp. (22 of 4485) each accounted
for 0.5% of pathogens. Comparing antimicrobial resistance among
<italic>Shigella</italic>
spp. and <italic>Salmonella</italic>
spp.
between two periods, February 2003 to February 2004 and July 2006 to July
2008, revealed an increase in ampicillin resistance among
<italic>Shigella</italic>
spp. from 43% to 83%
(p<0.001). Among <italic>Salmonella</italic>
spp., resistance to
chloramphenicol decreased from 56% to 6%
(p<0.001). The absence of stool white and red blood cells correlated
with a high specificity and negative predictive value.</p>
</sec>
<sec><title>Conclusions/Significance</title>
<p>Most gastroenteritis stools were culture and microscopy negative suggesting
that viral pathogens were the majority etiologic agents in this Botswana
cohort. <italic>Shigella</italic>
spp. and <italic>Salmonella</italic>
spp.
were the most common bacteria; <italic>Isospora</italic>
spp. and
<italic>Cryptosporidium</italic>
spp. were the most common parasites.
Resistance to commonly used antimicrobials is high and should be closely
monitored.</p>
</sec>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Bryce, J" uniqKey="Bryce J">J Bryce</name>
</author>
<author><name sortKey="Boschi Pinto, C" uniqKey="Boschi Pinto C">C Boschi-Pinto</name>
</author>
<author><name sortKey="Shibuya, K" uniqKey="Shibuya K">K Shibuya</name>
</author>
<author><name sortKey="Black, Re" uniqKey="Black R">RE Black</name>
</author>
</analytic>
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<biblStruct><analytic><author><name sortKey="Obimbo, Em" uniqKey="Obimbo E">EM Obimbo</name>
</author>
<author><name sortKey="Mbori Ngacha, Da" uniqKey="Mbori Ngacha D">DA Mbori-Ngacha</name>
</author>
<author><name sortKey="Ochieng, Jo" uniqKey="Ochieng J">JO Ochieng</name>
</author>
<author><name sortKey="Richardson, Ba" uniqKey="Richardson B">BA Richardson</name>
</author>
<author><name sortKey="Otieno, Pa" uniqKey="Otieno P">PA Otieno</name>
</author>
</analytic>
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</author>
<author><name sortKey="Tylleskar, T" uniqKey="Tylleskar T">T Tylleskar</name>
</author>
<author><name sortKey="Downing, R" uniqKey="Downing R">R Downing</name>
</author>
<author><name sortKey="Tumwine, Jk" uniqKey="Tumwine J">JK Tumwine</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Brink, Ak" uniqKey="Brink A">AK Brink</name>
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