Browsing by Author "Achan, Beatrice"

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    Distribution and antifungal susceptibility profile of oropharyngeal Candida species isolated from people living with HIV in the era of universal test and treat policy in Uganda
    (Therapeutic Advances in Infectious Disease, 2024-05-28) Musinguzi, Benson; Turyamuhika, Laban; Nalumaga, Pauline Petra; Njovu, Israel Kiiza; Mboowa , Gerald; Achan, Beatrice
    Despite the increased frequency of oropharyngeal candidiasis among people living with human immunodeficiency virus (HIV), its management is no longer effective due to empirical treatment and emergence of antifungal resistance (AFR). This study sought to investigate the prevalence of oropharyngeal candidiasis and assess the antifungal susceptibility profile of oropharyngeal Candida species isolated from people living with human immunodeficiency virus. Additionally, we evaluated the correlation between oropharyngeal candidiasis and CD4 T cell as well as viral load counts. A descriptive cross-sectional study was carried out from April to October 2023 in which 384 people living with HIV underwent clinical examination for oral lesions. Oropharyngeal swabs were collected and cultured on Sabouraud Dextrose agar to isolate Candida species which were identified using the matrix assisted laser desorption ionization time of flight mass spectrometry. Additionally, the antifungal susceptibility profile of Candida isolates to six antifungal drugs was determined using VITEK® (Marcy-l’Étoile, France) compact system. Data on viral load were retrieved from records, and CD4 T cell count test was performed using Becton Dickinson Biosciences fluorescent antibody cell sorter presto. The prevalence of oropharyngeal candidiasis was 7.6%. Oropharyngeal candidiasis was significantly associated with low CD4 T cell count and high viral load. A total of 35 isolates were obtained out of which Candida albicans comprised of 20 (57.1%) while C. tropicalis and C. glabrata comprised 4 (11.4%) each. C. parapsilosis, C. dubliniensis and C. krusei accounted for 2 (5.7%) each. Additionally, 7 (20%) isolates were resistant to fluconazole, 1 (2.9%) to flucytocine and 0.2 (5.7%) isolates were intermediate to caspofungin. However, specific specie isolates like C. albicans showed 20% (4/20), C. glabrata 50% (2/4) and C. krusei 50% (1/2) resistance to fluconazole. Additionally, C. krusei showed 50% resistance to flucytosine. The prevalence of oropharyngeal candidiasis (OPC) among people living with HIV was low, and there was a significant association between OPC and CD4 T cell count as well as viral load. C. albicans was the most frequently isolated oropharyngeal Candida species. C. glabrata and C. krusei exhibited the highest AFR among the non-albicans Candida species. The highest resistance was demonstrated to fluconazole.
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    Increased Antifungal Drug Resistance in Clinical Isolates of Cryptococcus neoformans in Uganda
    (Antimicrobial agents and chemotherapy, 2015-11-17) Smith, Kyle D.; Achan, Beatrice; Okagaki, Laura H.; Akampurira, Andrew; Kirsten Nielsen,a on behalf of the ASTRO-CM/COAT Team
    Cryptococcal 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 MIC50 of 4 μg/ml and an MIC90 of 8 μg/ml prior to widespread human fluconazole and agricultural azole fungicide usage, we report an upward shift in the fluconazole MIC50 to 8 μg/ml and an MIC90 value of 32 μg/ml, with 31% of isolates with a fluconazole MIC of ≥16 μg/ml. We observed an amphotericin B MIC50 of 0.5 μg/ml and an MIC90 of 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 analyzed Cryptococcus susceptibility to sertraline, with an MIC50 of 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).
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    Medical Mycology Dissertation Topics Require Prioritization among Postgraduate Microbiology trainees of Makerere University, Uganda
    (IJID Regions, 2022) Achan, Beatrice; Mboowa, Gerald; Kwizera, Richard; Kajumbula, Henry; Kateete, David P.; Bongomin, Felix
    As elsewhere worldwide, there is an increasing burden of fungal diseases in Uganda. However, expertise in medical mycology (the study of fungal diseases of medical importance) among clinicians and laboratory personnel remains low.This study sought to determine the proportion of dissertations on medical mycology among postgraduate medical microbiology trainees at the College of Health Sciences, Makerere University, Uganda.We retrospectively reviewed the topics of dissertations submitted to the Departments of Medical Microbiology and Immunology & Molecular Biology from 2011 through 2018. The proportion of dissertation topics on medical mycology was analysed using descriptive statistics.A total of 152 dissertations were retrieved. Of these, only 5 (3.3%) were on medical mycology compared to bacteriology (50.7%, n = 77), virology (27.6%, n = 42), parasitology (14.5%, n = 22) and immunology (4.0%, n = 6). Of the 5 dissertations on fungal diseases, the distribution was as follows: cryptococcal meningitis (40%, n = 2), Candidiasis (20%, n = 1), superficial mycoses (20%, n = 1) and other invasive fungal diseases (20%, n = 1). The most common method that was used for studying the fungal diseases was culture 60%, n = 3. There is limited research on medical mycology among the postgraduate medical microbiology trainees of Makerere University, Uganda.
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    Mycobacteriophages Exhibit Antibiofilm Activity at High Multiplicities of Infection
    (2022) Ssengooba, Willy; Kamya, Deus; Nakavuma, Jesca; Achan, Beatrice; Semanda, Joseph
    Biofilm formation has been shown to be a very effective survival mechanism used by many bacteria pathogens, including Mycobacterium tuberculosis (Mtb). However, unlike other bacteria, mycobacterial biofilms tend to be very rich in lipids, and this accords them much more resilience than their carbohydratebased counterparts’. Mycobacteriophage therapy, as an up-and-coming technology, is envisaged to revolutionize the treatment of tuberculosis (TB), particularly involving antibiotic-resistant Mtb. Antibiofilm activity, therefore, is a highly sought-after characteristic of mycobacteriophages intended for therapeutic use. Here we investigated the in-vitro activity of a three-phage cocktail against biofilms of forty-six clinically isolated Mtb using the MBEC biofilm device. We demonstrate that multiplicity of infection and the age of the biofilms are significant determinants of phage antibiofilm activity. Furthermore, based on our host range data, we hypothesize that mycobacteriophages might have a preference for Mtb hosts from pulmonary infection sites compared to those from extrapulmonary sites. If accurate, this finding could have profound implications for both diagnostic and therapeutic applications of mycobacteriophages. Overall, our findings demonstrate the antibiofilm potential of mycobacteriophages and continue to endorse mycobacteriophage therapy as a treatment alternative to our failing antibiotic arsenal. We recommend further investigations to; understand the basis of the observed host preference in mycobacteriophages, evaluate combinatorial therapy of phages and antibiotics, and screen the phages for undesirable genes.
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    Tossing the coin of extended-spectrum β-lactamase: prevalence of extended-spectrum β-lactamase- producing Klebsiella pneumoniae isolated from patients with sepsis
    (Access Microbiology, 2025-02-19) Achan, Beatrice; Luggya, Tonny; Ebwongu, Robert Innocent; Sekyanzi, Simon; Kajumbula, Henry
    Klebsiella pneumoniae is part of the ESKAPE (Enterococcus faecium, Staphylococcus aureus, K. pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) group of multidrug-resistant (MDR) pathogens. K. pneumoniae is the leading cause of antimicrobial resistance-associated mortality and the second leading cause of nosocomial bloodstream infections (BSIs), globally and in sub-Saharan Africa. Therefore, it was aimed to determine the antibiotic resistance patterns of K. pneumoniae isolated from blood cultures of patients with features of sepsis at Mulago National Referral Hospital, Uganda. The cross-sectional study on patients with features of sepsis utilized K. pneumoniae (n=30) isolated from positive blood culture specimens. The antibiotic resistance profile was determined by the Clinical and Laboratory Standards Institute’s Kirby–Bauer disc diffusion method, which was used to classify the isolates as susceptible, intermediate and resistant. K. pneumoniae isolates that were resistant to third-generation cephalosporins were subjected to extended-spectrum β-lactamase (ESBL) screening and confirmation using the double-disc synergy test using cefotaxime, ceftazidime, ceftriaxone, cefotaxime–clavulanic acid and ceftazidime–clavulanic acid. The results were analysed for frequencies. K. pneumoniae isolates showed emerging resistance to imipenem at 13% (4 out of 30) followed by amikacin at 17% (5 out of 30). There was intermediate resistance to gentamycin at 60% (18 out of 30). However, K. pneumoniae showed the highest resistance to piperacillin at 100% (30 out of 30) followed by sulphamethoxazole-trimethoprim and cefepime, both showing a percentage of 97% (29 out of 30). Up to 16 out of 30 (53.3%) of K. pneumoniae were positive for ESBL production, whilst 14 out of 30 (46.7%) were negative. There was a high prevalence of antibiotic-resistant ESBL-producing K. pneumoniae isolates from BSI of patients with features of sepsis in Uganda’s Mulago National Referral Hospital.