scholarly journals Increased Antifungal Drug Resistance in Clinical Isolates of Cryptococcus neoformans in Uganda

2015 ◽  
Vol 59 (12) ◽  
pp. 7197-7204 ◽  
Author(s):  
Kyle D. Smith ◽  
Beatrice Achan ◽  
Kathy Huppler Hullsiek ◽  
Tami R. McDonald ◽  
Laura H. Okagaki ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Low Income ◽  
Low Cost ◽  
Drug Susceptibility ◽  
Antifungal Drug ◽  
Clinical Isolates ◽  
Hiv Care ◽  
Low Income Countries ◽  
Broth Microdilution ◽  
Content Type

ABSTRACTCryptococcal antigen screening is recommended among people living with AIDS when entering HIV care with a CD4 count of <100 cells/μl, and preemptive fluconazole monotherapy treatment is recommended for those with subclinical cryptococcal antigenemia. Yet, knowledge is limited of current antimicrobial resistance in Africa. We examined antifungal drug susceptibility in 198 clinical isolates collected from Kampala, Uganda, between 2010 and 2014 using the CLSI broth microdilution assay. In comparison with two previous studies from 1998 to 1999 that reported an MIC50of 4 μg/ml and an MIC90of 8 μg/ml prior to widespread human fluconazole and agricultural azole fungicide usage, we report an upward shift in the fluconazole MIC50to 8 μg/ml and an MIC90value of 32 μg/ml, with 31% of isolates with a fluconazole MIC of ≥16 μg/ml. We observed an amphotericin B MIC50of 0.5 μg/ml and an MIC90of 1 μg/ml, of which 99.5% of isolates (197 of 198 isolates) were still susceptible. No correlation between MIC and clinical outcome was observed in the context of amphotericin B and fluconazole combination induction therapy. We also analyzedCryptococcussusceptibility to sertraline, with an MIC50of 4 μg/ml, suggesting that sertraline is a promising oral, low-cost, available, novel medication and a possible alternative to fluconazole. Although the CLSI broth microdilution assay is ideal to standardize results, limit human bias, and increase assay capacity, such assays are often inaccessible in low-income countries. Thus, we also developed and validated an assay that could easily be implemented in a resource-limited setting, with similar susceptibility results (P= 0.52).

scholarly journals Comparison of the MICs Obtained by Gradient Concentration Strip and EUCAST Methods for Four Azole Drugs and Amphotericin B against Azole-Susceptible and -Resistant Aspergillus Section Fumigati Clinical Isolates

2019 ◽  
Vol 64 (3) ◽  
Author(s):  
S. Dellière ◽  
L. Verdurme ◽  
J. Bigot ◽  
E. Dannaoui ◽  
Y. Senghor ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Sensu Stricto ◽  
Clinical Isolates ◽  
Broth Microdilution ◽  
Routine Testing ◽  
Content Type ◽  
Valuable Method ◽  
Resistant Strains ◽  
Potential Impact

ABSTRACT Reference methods used to assess the drug susceptibilities of Aspergillus fumigatus isolates consisted of EUCAST and CLSI standardized broth microdilution techniques. Considering the increasing rate and the potential impact on the clinical outcome of azole resistance in A. fumigatus, more suitable techniques for routine testing are needed. The gradient concentration strip (GCS) method has been favorably evaluated for yeast testing. The aim of this study was to compare the CGS test with EUCAST broth microdilution for amphotericin B (AMB), posaconazole (PCZ), itraconazole (ITZ), voriconazole (VRZ), and isavuconazole (ISA). A total of 121 Aspergillus section Fumigati strains were collected, including 24 A. fumigatus sensu stricto strains that were resistant to at least one azole drug. MICs were determined using GCS and EUCAST methods. Essential agreement between the 2 methods was considered when MICs fell within ±1 dilution or ±2 dilutions of the 2-fold dilution scale. Categorical agreement was defined as the percentage of strains classified in the same category (susceptible, intermediate, or resistant) with both methods. Essential agreements with ±1 dilution and ±2 dilutions were 96.7, 93.4, 90.0, 89.3, and 95% and 100, 99.2, 100, 97.5, and 100% for AMB, PCZ, ITZ, VRZ, and ISA, respectively. Categorical agreements were 94.3, 86.1, 89.3, and 88.5% for AMB, PCZ, ITZ, and VRZ, respectively. Detection of resistance was missed with the GCS for one strain (4.1%) for PCZ and for 2 strains (8.3%) for ISA. Determination of ITZ MICs using the GCS allowed the detection of 91.7% of azole-resistant strains. The GCS test appears to be a valuable method for screening azole-resistant A. fumigatus clinical isolates.

scholarly journals Evaluation of a Low-Cost Commercial Actigraph and Its Potential Use in Detecting Cultural Variations in Physical Activity and Sleep

Sensors ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 3774
Author(s):  
Pavlos Topalidis ◽  
Cristina Florea ◽  
Esther-Sevil Eigl ◽  
Anton Kurapov ◽  
Carlos Alberto Beltran Leon ◽  
...  
Keyword(s):  
Physical Activity ◽  
Low Income ◽  
Large Scale ◽  
Low Cost ◽  
Low Income Countries ◽  
Time Data ◽  
Cultural Variations ◽  
Step Counts ◽  
Scale Step ◽  
Potential Use

The purpose of the present study was to evaluate the performance of a low-cost commercial smartwatch, the Xiaomi Mi Band (MB), in extracting physical activity and sleep-related measures and show its potential use in addressing questions that require large-scale real-time data and/or intercultural data including low-income countries. We evaluated physical activity and sleep-related measures and discussed the potential application of such devices for large-scale step and sleep data acquisition. To that end, we conducted two separate studies. In Study 1, we evaluated the performance of MB by comparing it to the GT3X (ActiGraph, wGT3X-BT), a scientific actigraph used in research, as well as subjective sleep reports. In Study 2, we distributed the MB across four countries (Austria, Germany, Cuba, and Ukraine) and investigated physical activity and sleep among these countries. The results of Study 1 indicated that MB step counts correlated highly with the scientific GT3X device, but did display biases. In addition, the MB-derived wake-up and total-sleep-times showed high agreement with subjective reports, but partly deviated from GT3X predictions. Study 2 revealed similar MB step counts across countries, but significant later wake-up and bedtimes for Ukraine than the other countries. We hope that our studies will stimulate future large-scale sensor-based physical activity and sleep research studies, including various cultures.

scholarly journals Antimicrobial Susceptibility Patterns among a Large, Nationwide Cohort of Abiotrophia and Granulicatella Clinical Isolates

2017 ◽  
Vol 55 (4) ◽  
pp. 1025-1031 ◽  
Author(s):  
Kunatum Prasidthrathsint ◽  
Mark A. Fisher
Keyword(s):  
Antimicrobial Susceptibility ◽  
Clinical Isolates ◽  
Broth Microdilution ◽  
Content Type ◽  
Geographical Regions ◽  
Susceptibility Patterns

ABSTRACTAntimicrobial susceptibility patterns from 599A. defectiva,G. adiacens, andG. elegansclinical isolates were determined by broth microdilution. We observed significant differences in susceptibility across species, particularly to penicillin and ceftriaxone, and across geographical regions.A. defectivawas the least susceptible species overall to penicillin. All isolates were susceptible to vancomycin and >90% were susceptible to levofloxacin.

scholarly journals Trends in Antifungal Drug Susceptibility of Cryptococcus neoformans Isolates Obtained through Population-Based Surveillance in South Africa in 2002-2003 and 2007-2008

2011 ◽  
Vol 55 (6) ◽  
pp. 2606-2611 ◽  
Author(s):  
Nelesh P. Govender ◽  
Jaymati Patel ◽  
Marelize van Wyk ◽  
Tom M. Chiller ◽  
Shawn R. Lockhart ◽  
...  
Keyword(s):  
South Africa ◽  
Cryptococcus Neoformans ◽  
Amphotericin B ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Drug Susceptibility ◽  
Population Based ◽  
Content Type ◽  
Microdilution Method ◽  
Broth Microdilution Method

ABSTRACTCryptococcus neoformansis the most common cause of meningitis among adult South Africans with HIV infection/AIDS. Widespread use of fluconazole for treatment of cryptococcal meningitis and other HIV-associated opportunistic fungal infections in South Africa may lead to the emergence of isolates with reduced fluconazole susceptibility. MIC testing using a reference broth microdilution method was used to determine if isolates with reduced susceptibility to fluconazole or amphotericin B had emerged among cases of incident disease. Incident isolates were tested from two surveillance periods (2002-2003 and 2007-2008) when population-based surveillance was conducted in Gauteng Province, South Africa. These isolates were also tested for susceptibility to flucytosine, itraconazole, voriconazole, and posaconazole. Serially collected isolate pairs from cases at several large South African hospitals were also tested for susceptibility to fluconazole. Of the 487 incident isolates tested, only 3 (0.6%) demonstrated a fluconazole MIC of ≥16 μg/ml; all of these isolates were from 2002-2003. All incident isolates were inhibited by very low concentrations of amphotericin B and exhibited very low MICs to voriconazole and posaconazole. Of 67 cases with serially collected isolate pairs, only 1 case was detected where the isolate collected more than 30 days later had a fluconazole MIC value significantly higher than the MIC of the corresponding incident isolate. Although routine antifungal susceptibility testing of incident isolates is not currently recommended in clinical settings, it is still clearly important for public health to periodically monitor for the emergence of resistance.

Antifungal drug susceptibility of oralCandida albicansisolates may be associated with apoptotic responses to Amphotericin B

2010 ◽  
Vol 39 (2) ◽  
pp. 182-187 ◽  
Author(s):  
Chengzhe Yang ◽  
Weiyu Gong ◽  
Jingting Lu ◽  
Xiujuan Zhu ◽  
Qingguo Qi
Keyword(s):  
Amphotericin B ◽  
Drug Susceptibility ◽  
Antifungal Drug

Foreign capital inflows and economic growth: the experience of low-income countries in Sub Saharan Africa

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Atif Awad
Keyword(s):  
Low Income ◽  
Foreign Capital ◽  
Ordinary Least Squares ◽  
Capital Inflows ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Content Type ◽  
Long Run ◽  
Foreign Capital Inflows ◽  
The Impact

Purpose This paper aims to investigate the long-run impact of selected foreign capital inflows, including aid, remittances, foreign direct investment (FDI), trade and debt, on the economic growth of 21 low-income countries in the Sub Saharan Africa (SSA) region, during the period 1990–2018. Design/methodology/approach To obtain this objective and for robust analysis, a parametric approach, which was dynamic ordinary least squares, and a non-parametric technique, which was fully modified ordinary least squares, were used. Findings The results of both models confirmed that, in the long run, trade and aid affected the growth rate of the per capita income in these countries in a positive way. However, external debt seemed to have an adverse influence on such growth. Originality/value First, this is the initial study that has addressed this matter across a homogenous group of countries in the SSA region. Second, while most of the previous studies regarding capital inflows into the SSA region have focused on the impact of only one or two aspects of such foreign capital inflows on growth, the present study, instead, examined the impact of five types of foreign capital inflows (aid, remittances, FDI, trade and debt).

Private school vouchers for expanding secondary school access? The case of Tanzania

2018 ◽  
Vol 32 (7) ◽  
pp. 1307-1318
Author(s):  
Donald R. Baum ◽  
Jacobus Cilliers
Keyword(s):  
Secondary Education ◽  
Secondary School ◽  
Low Income ◽  
Private School ◽  
Systems Approach ◽  
Financial Burden ◽  
Low Income Countries ◽  
Urban District ◽  
Content Type ◽  
School Voucher

Purpose The purpose of this paper is to provide insight into the current contributions of private schools to education provision in Tanzania, and to consider the feasibility of a school voucher program to contribute to the expansion of the secondary school system, compared to the alternative expansion of public secondary education. Design/methodology/approach The study offers an analysis of current educational circumstances and educational goals in Tanzania, and projects differential costs and outcomes associated with various options for expanding secondary education. Data come from two sources: a census of the private schooling market in the Morogoro Urban district, conducted as part of the World Bank’s Systems Approach for Better Education Results initiative; and Tanzania’s National Panel Survey 2010–2011. Findings For those students unable to cover the full cost of secondary education, findings suggest that a targeted private school voucher would be an efficient and equitable policy mechanism for secondary school expansion. Such an approach would ease the financial burden on government for constructing all new schools, yet assure access for the most vulnerable. Originality/value The implementation of school voucher programs is increasing in low-income countries. It is important for policy makers to carefully consider the appropriateness of this type of policy intervention for their particular educational contexts. This paper models an approach by which researchers and policymakers can assess the educational circumstances of a particular location, and determine the potential effectiveness of a private school voucher policy.

Sustainable housing financing model to reduce South Africa housing deficit

2017 ◽  
Vol 10 (3) ◽  
pp. 410-430 ◽  
Author(s):  
Bashir Olanrewaju Ganiyu ◽  
Julius Ayodeji Fapohunda ◽  
Rainer Haldenwang
Keyword(s):  
South Africa ◽  
South African ◽  
Affordable Housing ◽  
Low Income ◽  
Low Cost ◽  
South African Government ◽  
The South ◽  
African Government ◽  
Content Type ◽  
Mortgage Payment

Purpose This study aims to identify and establish effective housing financing concepts to be adopted by government in achieving its mandate of providing sustainable affordable housing for the poor to decrease the building of shacks, as well as proposing solutions to the housing deficit in South Africa. A rise in demand and shortage in supply of housing calls for the need to address issues of affordable housing in South Africa, and developing countries in general, to ensure a stable and promising future for poor families. Design/methodology/approach Literature has revealed that the South African government, at all levels, accorded high priority to the provision of low-cost housing. Thus, government has adopted subsidy payment as a method of financing affordable housing to ensure that houses are allocated free to the beneficiaries. This also addresses the historically race-based inequalities of the past, but unfortunately, this has not been fully realised. This study uses a sequential mixed method approach, where private housing developers and general building contractors were the research participants. The qualitative data were analysed using a case-by-case analysis, and quantitative data were analysed using a descriptive statistical technique on SPSS. Findings The results of the qualitative analysis reveal a gross abuse of the housing subsidies system by the beneficiaries of government-funded housing in South Africa. This is evident from illegal sale of the houses below market value. This has led to a continual building of shacks and an increased number of people on the housing waiting list instead of a decrease in the housing deficit. The results from quantitative analysis affirm the use of “Mortgage Payment Subsidies, Mortgage Payment Deductions, Down-Payment Grant and Mortgage Interest Deductions” as viable alternatives to subsidy payment currently in use to finance affordable housing projects by the South African Government. Practical implications At the moment, the focus of the South African National Government is continual provision of free housing to the historically disadvantage citizens, but the housing financing method being used encourages unapproved transfer of ownership in the affordable housing sector. This study thus recommends the use of an all-inclusive housing financing method that requires a monetary contribution from the beneficiaries to enable them take control of the process. Originality/value The relational interface model proposed in this study will reduce pressure on government budgetary provision for housing and guarantee quick return of private developers’ investment in housing. Government must, as a matter of urgency, launch a continuous awareness programme to educate the low-income population on the value and the long-term benefits of the housing.

scholarly journals Deletion ofADA2Increases Antifungal Drug Susceptibility and Virulence inCandida glabrata

2018 ◽  
Vol 62 (3) ◽  
Author(s):  
Shang-Jie Yu ◽  
Ya-Lin Chang ◽  
Ying-Lien Chen
Keyword(s):  
Cell Wall ◽  
Systemic Infection ◽  
Drug Tolerance ◽  
Drug Susceptibility ◽  
Antifungal Drugs ◽  
Antifungal Drug ◽  
Saga Complex ◽  
Necrosis Factor Alpha ◽  
Content Type ◽  
Downstream Target

ABSTRACTCandida glabrata, the second most frequent cause of candidiasis afterCandida albicans, is an emerging human fungal pathogen that is intrinsically drug tolerant. Currently, studies ofC. glabratagenes involved in drug tolerance are limited. Ada2, a component serving as a transcription adaptor of the Spt-Ada-Gcn5 acetyltransferase (SAGA) complex, is required for antifungal drug tolerance and virulence inC. albicans. However, its roles inC. glabrataremain elusive. In this study, we found thatada2mutants demonstrated severe growth defects at 40°C but only mild defects at 37°C or 25°C. In addition,C. glabrata ada2mutants exhibited pleiotropic phenotypes, including susceptibility to three classes of antifungal drugs (i.e., azoles, echinocandins, and polyenes) and cell wall-perturbing agents but resistance to the endoplasmic reticulum stressor tunicamycin. According to RNA sequence analysis, the expression of 43 genes was downregulated and the expression of 442 genes was upregulated in theada2mutant compared to their expression in the wild type.C. glabrata ADA2, along with its downstream targetERG6, controls antifungal drug tolerance and cell wall integrity. Surprisingly,ada2mutants were hypervirulent in a murine model of systemic infection, possibly due to the upregulation of multiple adhesin-like genes, increased agar invasion, and overstimulation of murine tumor necrosis factor alpha production.

scholarly journals Antifungal Susceptibility Testing of Malassezia spp. with an Optimized Colorimetric Broth Microdilution Method

2017 ◽  
Vol 55 (6) ◽  
pp. 1883-1893 ◽  
Author(s):  
Cheryl Leong ◽  
Antonino Buttafuoco ◽  
Martin Glatz ◽  
Philipp P. Bosshard
Keyword(s):  
Susceptibility Testing ◽  
Skin Diseases ◽  
Antifungal Susceptibility ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Broth Microdilution ◽  
Content Type ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
Colorimetric Indicator

ABSTRACTMalasseziais a genus of lipid-dependent yeasts. It is associated with common skin diseases such as pityriasis versicolor and atopic dermatitis and can cause systemic infections in immunocompromised individuals. Owing to the slow growth and lipid requirements of these fastidious yeasts, convenient and reliable antifungal drug susceptibility testing assays forMalasseziaspp. are not widely available. Therefore, we optimized a broth microdilution assay for the testing ofMalasseziathat is based on the CLSI and EUCAST assays forCandidaand other yeasts. The addition of ingredients such as lipids and esculin provided a broth medium formulation that enabled the growth of allMalasseziaspp. and could be read, with the colorimetric indicator resazurin, by visual and fluorescence readings. We tested the susceptibility of 52 strains of 13Malasseziaspecies to 11 commonly used antifungals. MIC values determined by visual readings were in good agreement with MIC values determined by fluorescence readings. The lowest MICs were found for the azoles itraconazole, posaconazole, and voriconazole, with MIC90values of 0.03 to 1.0 μg/ml, 0.06 to 0.5 μg/ml, and 0.03 to 2.0 μg/ml, respectively. AllMalasseziaspp. were resistant to echinocandins and griseofulvin. SomeMalasseziaspp. also showed high MIC values for ketoconazole, which is the most widely recommended topical antifungal to treatMalasseziaskin infections. In summary, our assay enables the fast and reliable susceptibility testing ofMalasseziaspp. with a large panel of different antifungals.

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