RATIONALEThe prevalence of interstitial lung disease (ILD) in East Africa is understudied owing to the limited availability of high-resolution computed tomography (HRCT) and highly trained pulmonary physicians and radiologists. We sought to characterize the epidemiology, clinical presentation and ILD subtypes in Ethiopia to inform future public health policy and care.METHODSIn this prospective institution-based study, the patient sample was drawn from patients who had HRCT as part of their evaluation for chronic dyspnea at Tikur Anbessa Specialized Hospital (TASH) seen from October 1, 2020-September 30, 2024. Demographics, co-morbid conditions, clinical presentation, potential risk factors, spirometry values, and HRCT results were all obtained by chart review. Two clinicians independently categorized ILD subtype based on clinical presentation and HRCT findings and compared statistically between groups.RESULTS96 patients with ILD were identified. Hypersensitivity pneumonitis(HP) (n=26; 27.1%) and sarcoidosis (n=25; 26%) were the most prevalent diagnoses, followed by Idiopathic pulmonary fibrosis(IPF) (n=16;16.7%), idiopathic non-specific interstitial pneumonitis (iNSIP) (n=13; 13.5%), Connective tissue associated (CTD ILD(n=10;10.4%), Organizing pneumonia (n=3; 3.1%), Lymphangioleiomyomatosis (LAM)(n=2; 2%), and Chronic eosinophilic pneumonia (CEP)(n=1; 1%). Median age (IQR) of participants was 49 years (40-64 years) and 39 (40.6%) were males. The most common symptom was cough 81 (84.4%), followed by dyspnea 79 (82.3%) with a median duration of 12 and 15 months (IQR 3-36 months) respectively before diagnosis. 24% of the patients had a history of tuberculosis, highest among subjects with sarcoidosis (44%), P=0.041. Only 12.5 % of participants were smokers, highest being in patients with IPF (31.3%), p=0.022. Thirty-three (33.4%) utilized household fuel for cooking, highest among subjects with IPF (56.3%), p=0.039 (Table1). For the 47 patients who underwent spirometry, the median FVC was 2.33 L (IQR 1.96-2.92), median FVC percent predicted 80% (IQR 67.0-88.0), Only 33 (33.4%) had been diagnosed correctly on before referral, with, 42.1% having been referred for a suspicion of tuberculosis.CONCLUSION Hypersensitivity pneumonitis and sarcoidosis were the most common diagnoses in contrast to developed countries, acknowledging likely referral bias. Participants with IPF had higher exposure to smoking and home fuel. Prior TB was higher among participants with sarcoidosis. ILD cases were frequently unrecognized or misdiagnosed, reflecting a lack of awareness of ILD among physicians in the community. Bridging the physician knowledge gap and increasing diagnostic facilities at health facilities should be prioritized to improve the management of ILD in Ethiopia. Prospective studies are needed to determine the risk factors of ILD in Ethiopia.

Introduction: Tuberculosis (TB) is a global public health problem causing significant morbidity and mortality, particularly in low and middle income countries (LMIC). Globally, one-third of TB cases are missed, making the fight against TB more challenging. This study aims to determine the role of Artificial Intelligence enabled CXR interpretation in the detection of pulmonary TB in Ethiopia. Methods: This is a prospective single-arm cohort study conducted in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia from January to September 2024. Ethical approval was obtained from the Institutional Review Board of the College of Health Sciences, Addis Ababa University. Consecutive CXRs considered technically acceptable from adults 18 years and above who consented to follow-up based on AI-based CXR reading were included in the study. Confirmed TB cases and patients not willing to come were excluded. Data on socio-demographics, indications for CXR, presenting symptoms, risk factors, and AI-based CXR findings were collected. The AI-based CXR software (Qure.ai, India) processed all chest X-rays that met the eligibility requirements throughout the study period. Once AI-based CXR software flagged an image as high risk for pulmonary TB, the image was reevaluated by a senior radiologist; if the radiologist agreed, a sputum sample was sent for Xpert MTB/RIF. All TB cases identified clinically or bacteriologically were linked to the TB clinic for treatment. Result: A total of 3351 CXRs were pushed to the AI-based software and 552 (16.5%) scans were flagged as suggestive of pulmonary TB. Senior Radiologists evaluated a total of 521 (94.4%) flagged CXR, of which 47 (9.0%) aligned with their interpretation and were eligible for GeneXpert. GeneXpert was performed for 30 participants (71.1%). Of the remaining 17 patients, 10 were lost to follow-up, 6 were unable to give samples but had chest CT to rule out TB, and the remaining 1 patient was unable to give a sample but evaluated by a pulmonologist and TB ruled out. Ten patients with bacteriologically confirmed TB were linked to TB clinic. Out of ten patients with bacteriologically confirmed tuberculosis, CXR was done for possible PTB in seven patients, for CAP in two, and for a medical certificate screening in one. The median age of patients flagged for TB was 48 years and majority were females, 52% Conclusion: This ongoing study showed that AI-based CXR software identified additional active pulmonary cases. AI-based CXR implementation may help to increase case detection and early diagnosis of TB in LMIC settings.

Background: TB is still a problem worldwide despite efforts to eradicate it, and co-infection with fungal diseases presents a serious risk. Objective: To ascertain the frequency and causes of TB fungal co-infection and tuberculosis in individuals with lower respiratory tract infection symptoms. Materials and methods: A prospective hospital-based, cross-sectional study was conducted at the study site through November 2023 and May 2024. From 530 study participants, sputum samples were obtained. Using a GeneXpert equipment, a portion of the sputum was used for the diagnosis of tuberculosis. The remaining sample was grown, and the fungal isolates were identified using conventional microbiological techniques. Results: 530 sputum samples in all were gathered, and the samples were tested for lower respiratory tract infections. Males were slightly less than females and middle-aged to elderly study subjects were dominant. Forty-seven (7.9 %) samples were Gene Xpert positive and 189 (36.7 %) samples were fungal culture positive. Of 42 Gene Xpert-positive patients 23(4.3 %) were infected with TB only and 19(3.9 %) patients were TB co-infected with fungal pathogens. Cough was the most common sign and symptom accounting for 99.2 %. Among chest radiograph abnormalities 45(8.5 %%) patients had cavity lesions. Different chest radiograph classifications showed different distributions of the organisms found in sputum (p < 0.001). About 21 (4.0 %) study subjects were with diabetes where 12 were with fungal infection, 2 were TB co-infected with fungal pathogens. Conclusion: Of the 42 Xpert-positive patients with respiratory infection symptoms who were tested for TB and fungal pathogens, 23 (4.3 %) had tuberculosis exclusively, and 19 (3.9 %) had co-infections of TB and fungal pathogens. Among fungal isolates, 183 (75.9 %) were yeasts while 58 (24.1 %) isolates were molds. Among fungal isolates, 183 (75.9 %) were yeasts while 58 (24.1 %) isolates were molds. Fungal pathogen screening should be done concurrently with tuberculosis screening.

Abstract Background In 2018, an estimated 10 million people developed tuberculosis, of whom more than 1.45 million died. The microscopy method used in most tuberculosis high burden and resource-limited countries is less accurate for diagnosing the disease. Thus, evaluation of the available diagnostic modalities in the country is crucial, and this study aimed to evaluate the performance of Abbott real-time PCR as a diagnostic technique for tuberculosis in Ethiopia. Methods A cross-sectional survey was conducted using sputum specimens collected from 150 presumptive tuberculosis patients from both public and private health facilities in Addis Ababa, Ethiopia, from May to June 2019. The laboratory investigation was conducted at the National Reference Laboratories of the Ethiopian Public Health Institute (EPHI). Results This finding indicated that 84.7% (127/150) and 61.3% (92/150) were smear and culture-negative, respectively. The overall diagnostic sensitivity of the Abbott real-time polymerase chain reaction (PCR) technique for the diagnosis of tuberculosis was 89.7% (52/58), that for smear-negative was 80.6% (29/36), and that for specificity was 92.4% (85/92). Drug resistance testing demonstrated diagnostic specificities of 87.5% and 100% for isoniazid and rifampicin, respectively, and a sensitivity of 92.3% for both. Conclusions This study demonstrated an outstanding performance of the Abbott real-time PCR technique for diagnosing tuberculosis using sputum specimens using culture as a reference standard. Thus, we recommend that Ethiopia's ministry and tuberculosis program implementers consider the Abbott real-time PCR technique for diagnosing tuberculosis and drug resistance testing, which is likely to be included in the national guidelines.

Bloodstream infection coupled with drug resistance in bloodborne bacteria is a major health problem globally. The current study sought to identify the bacterial spectrum, extended-spectrum -lactamase production, and antimicrobial resistance pattern in patients with bloodstream infection. This prospective cross-sectional study was conducted at Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia from January 2019- until July 2020. Blood collected from patients was inoculated into blood culture bottles and incubated appropriately. Identification, antimicrobial susceptibility testing, and extended-spectrum β-lactamase-production were determined with the VITEK 2 compact system. Of the samples collected, 156 (18.5%) were culture-positive. Klebsiella pneumoniae and Staphylococcus epidermidis were the dominant isolates. In Gram-negative bacteria, the prevalence of drug resistance was the highest against ampicillin (80.8%) and the lowest against imipenem (5.2%). While in Gram-positive bacteria it was the highest against clindamycin and the lowest against vancomycin and daptomycin. The prevalence of multi-drug resistance and extended-spectrum β-lactamase production of Gram-negative bacteria were 41.6% and 34.2%, respectively. The prevalence of bloodstream infection was 18.5%. Serious life-threatening pathogens including S . aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli , and Enterobacter spp was predominant. The prevalence of multi-drug resistance to both Gram-positive and Gram-negative bacteria and extended-spectrum β-lactamase-production were high but prevalence of carbapenem resistance was low. All these situations call for the establishment of strong infection control strategies, a drug regulatory system, and established antibiotic stewardship in healthcare settings.

Background In developing countries, the co-existence of a high burden of infectious diseases caused by Gram-negative bacteria and the rapid increase and spread of multidrug-resistant bacteria have become a serious health threat. Objective Profiling of Gram-negative bacteria and determining the magnitude of their antimicrobial resistance among patients. Results A total of 175 non-spore-forming Gram-negative bacteria were isolated from 873 different clinical samples. Of a total of 175 bacteria, 154 (88%) were fermentative Gram-negative bacteria, while 21 (12%) were non-fermentative Gram-negative bacteria . E. coli with a frequency of 58.3% and K. pneumoniae with a frequency of 18.3% were the predominant fermentative Gram-negative bacteria, while P. aeruginosa 9 (5.1%) and A. baumannii 6 (3.4%) were the predominant non-fermentative Gram-negative bacteria. The highest percentage level of antibiotic resistance was seen against ampicillin (86%), and the lowest against meropenem (9.8). About 49 (28%) Gram-negative bacilli were positive for ESBLase. The overall prevalence rate of MDR bacteria was 80.5%, of which 100% of A. baumannii , 90.6% of K. pneumonia. Sixteen isolates were resistant to meropenem, out of which 11 tested for carbapenemase production. Five of the nine were metallo-lactamase producers, with the remaining four being serine carbapenemase producers. Conclusion The prevalence of Gram-negative bacterial infection was found to be 20%, with a significant proportion (80.0%) due to fermentative Gram-negative bacteria and the remaining 20% due to non-fermentative Gram-negative bacteria. The study has also demonstrated a high prevalence rate of MDR, ESBLase, and carbapenemase-producing Gram-negative bacteria. Antimicrobial resistance of Gram-negative bacteria should be monitored on a regular basis, and an effective infection control program should be implemented.

Objective This work aimed to determine the magnitude of tinea capitis, the diversity and species composition of fungi, and the predominant dermatophytes implicated in causing tinea capitis. Methods A prospective, cross-sectional study was conducted at a dermatology clinic. Scalp scrapings were collected and cultured, and dermatophyte and non-dermatophyte molds were identified. Results Of 364 scalp scrapings, fungi were recovered from 301 (82.7%) clinical samples. About 60.7% of the samples were collected from women, while 39.3% were collected from male study subjects. The association between the magnitude of scalp ringworm and gender was not statistically significant (P = 0.105). Two hundred eighty study subjects were less than 15 years of age, of which 254 were culture positive. The association of tinea capitis and the age of patients was statistically significant (P = 0). Three hundred forty-nine fungal isolates were isolated, of which 54.2% were dermatophytes, while 45.8% were non-dermatophyte molds. The occurrence of dermatophytes in their decreasing order was T. violaceum (138; 73%), Trichophyton mentagrophytes (18; 9.5%), Trichophyton tonsurans (16; 8.5%), Trichophyton verrucosum (8; 4.5%), Microsporum audouinii (7; 3.7%), Trichophyton schoenleinii (1; 0.5%), and Trichophyton soudanense (1; 0.5%). Conclusion A high prevalence rate of T. violaceum-induced tinea capitis was reported. The magnitude of scalp ringworm in adults was remarkably high. Therefore, conducting a nationwide epidemiological survey on tinea capitis regardless of age is suggested. The isolation of many non-dermatophyte molds in the current study may shade questions about the perception that tinea capitis is caused by dermatophytes only. Therefore, studies on their potential pathogenic role on skin and skin-related (nail and the scalp) infections appear to be an active field of research.

Background Gram-positive cocci are clinically important pathogens that cause infections and their development of antibiotic resistance continues to pose a severe threat to public health. Therefore, this study aims to investigate the level of antimicrobial resistance among Gram-positive cocci isolated from different clinical samples among patients referred to Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia. Methods From January to April 2018, a cross-sectional study was conducted at Arsho Advanced Medical Laboratory. Seven hundred ninety-two (792) different clinical samples were obtained from 792 individuals and inoculated into blood culture bottles and Blood Agar base. Bacterial identification was done using the number, type, and morphology of colonies, as well as Gram staining, catalase testing, and coagulase test after isolation of pure growth on culture media using the standard operating procedure. VITEK 2 compact system was used for bacterial identification and drug susceptibility testing. The information entry and analysis were performed by using SPSS version 20. Results Out of 792 clinical samples cultured, the prevalence of Gram-positive cocci was 12.6% (n=100/792). The most frequent one is S. aureus 54% (n=54/100) followed by coagulase-negative Staphylococcus species 42% (n=42/100), S. agalactiae 1% (n=1/100) and E. faecalis 3% (n=3/100). Penicillin showed the highest resistance rate 85% (n=85/100), followed by sulfamethoxazole/trimethoprim (47%), and oxacillin (38%); however, highest sensitivity was seen towards linezolid 97% (n=97/100) and vancomycin 94% (n=94/100). The total multi-drug resistance (MDR) Gram-positive cocci were 44% (n=44/100). Conclusion This study demonstrated high antimicrobial resistance and multi-drug resistance. This suggests that the importance of continuous monitoring of antimicrobial resistance patterns is crucial for selecting the suitable drug for treatment and infection prevention.

Background: Urinary tract infection is a common infection in pediatrics. Understanding the common etiology of urinary tract infections, their antimicrobial susceptibility pattern, and associated risk factors in a particular setting can provide evidence for the appropriate treatment of the cases. Purpose: The current study is aimed to determine the common etiology and prevalence of uropathogens associated with urinary tract infection, as well as the antibiotic susceptibility profile of bacterial isolates, and to identify risk factors associated with urinary tract infection among pediatric patients. Materials and Methods: The study was conducted at St. Paul Hospital Millennium Medical College between October 2019 and July 2020. Urine was collected aseptically from patients, inoculated onto culture media, and incubated at 37 degrees C for 18-48 hours. Bacteria and yeast were identified following standard procedures. Antibiotic susceptibility testing of bacterial pathogens was carried out by the Kirby Bauer disc diffusion method. Descriptive statistics and logistical regressions were used to estimate the crude ratio with a 95% confidence interval. P-value < 0.05 was considered significant. Results: Significant bacterial/fungal growth was observed in 65 samples giving a prevalence of 28.6% of which 75.4% (49/65) and 24.6% (16/65) were bacterial and fungal pathogens, respectively. About 79.6% of bacterial etiology were Escherichia coli and Klebsiella pneumoniae. The highest resistance was observed against ampicillin (100%), cefazolin (92.1%), and trimethoprimsulfamethoxazole (84.1%), both of which are commonly used for empirical treatment in Ethiopia. Length of hospital stay (P=0.01) and catheterization (P=0.04) were statistically associated with urinary tract infection. Conclusion: The high prevalence of urinary tract infection was observed in our study. Enterobacteriaceae were the major cause of urinary tract infection. Length of hospital stay and catheterization were significantly associated with urinary tract infection. Both Gram-negative and Gram-positive bacteria were extremely resistant to ampicillin and trimethoprim-sulfamethoxazole.

BackgroundCatheter-associated urinary tract infection is the leading cause of hospital-acquired infections. They remain the second most common healthcare-associated infection in critically sick patients.ObjectiveTo determine the prevalence of catheter-associated urinary tract infection, the spectrum of etiological agents, antibiotic sensitivity profile of bacterial pathogens among adult patients admitted to intensive care units.Materials and methodsPatients admitted to the intensive care unit of hospitals in Addis Ababa who were on urethral indwelling catheters for >48 hours from October 2020 to September 2021 were included in the study. Urine specimens were aseptically collected and processed as per standard protocols. Microorganisms were isolated, identified, and subjected to antibiotic susceptibility testing.ResultsIn all 220 pateints included in the study development of significant bacteriuria/candiduria was not affected by sex, age, and prior antibiotic therapy. However, the length of stay in the intensive care unit was significantly associated with bacteriuria /candiduria (P-value < 0.001). The overall prevalence of bacteriuria/candiduria was 51.4% among which 21.0%, 19.1%, and 11.4% were bacteriuria, candiduria, and polymicrobial infections, respectively. About 138 organisms were recovered of which 79 (57.25%) were bacteria and 59 (42.75%) were yeast isolates. Acinetobacter species, Pseudomonas species, Klebsiella species E. coli, and Enterococcus species were the dominant bacterial isolates. Candida. albicans, Candida. krusei and Candida. tropicalis were the commonest yeasts. Many gram-negative bacterial isolates were resistant to ceftriaxone 36(94.7%), ampicillin 21(91.3%) followed by cefotaxime34(89.5%), amikacin (16.0%), nitrofurantoin (17.4%), meropenem (20.0%) and imipenem (20.0%). Out of 79 bacterial pathogens, 52(65.8%) were multiple antibiotic resistant of which 37(71.0%) were Gram-negative bacteria and 15(29%%) were Gram-positive bacteria. About 13(86.7%) isolates of Acinetobacter, all isolates of Klebsiella species (100%) and E. coli (100%) were multiple antibiotic-resistant. Out Of 18,10(55.56%), isolates of Enterococcus were multiple antibiotic-resistant.ConclusionsA very high prevalence of bacteriuria/ candiduria was demonstrated in this study. This warrants the establishment of multidimensional infection control approach on catheter associated urinary tract infection in ICU. In addition to high prevalence of candiduria, recovery of non-albicans candida species almost in equal proportion with candida albicans in the present study was an important finding as non-albicans candida species distinct to C. albicans are intrinsically resistant to the commonly used azole antifungal drugs in Ethiopia. The prevalence of rate MDR bacteria in our ICU particularly of E. coli, Klebsiella spp, Pseudomonas and Acetobacter spp was very high. In order to combat this problem, proper antibiotic policies should be formulated.

Background:Understanding the proportion of blood and blood products contamination during transfusion is important in developing infection control strategy in the health system. Therefore, this study was aimed to determine bacterial contamination and susceptibility patterns among blood and blood components at Armed Forces Comprehensive Specialized Hospital, Addis Ababa, Ethiopia.Methods:A cross-sectional study was done on blood and blood components collected with both diverging and none-diverging methods. Simple random sampling method was applied to select blood and blood product units from the record form and 10 mL of sample was drawn from each blood and blood product. Culturing from collected blood and blood products and antimicrobial sensitivity tests were done. The collected data were entered and analyzed by SPSS statistical software version 20. Binary and multiple logistic regression analysis were done to see different factors and p-values less than 0.05 were taken as statistically significant.Results:A total of three hundred seventy six (376) units of blood and blood product samples, 188 from non-diverging and 188 from diverging blood donor collection methods were included. Among different blood group types, O+ blood and the majority of components were stored from one to five days. The overall bacterial contamination among blood and blood components were n = 17 (4.5%). Among them, n = 14 (7.4%) and n = 3 (1.6%) were collected with a non-diverging and diverging method, respectively. Staphylococcus epidermidis was the most dominant isolate. Most bacterial isolates were susceptible to different antimicrobial agents; however, Pseudomonas aeruginosa showed resistance for gentamicin. The non-diverging collection units of blood and components were significantly associated with bacterial contamination. Of all, n = 5/17 (29.4%) isolated bacteria were multidrug resistant.Conclusion:The bacterial contamination of blood and blood components collected with diverging method was lower and recommended to use this collection method from donors.

Background: Onychomycosis is a common refractory fungal infection associated with significant morbidity. The objective of this study was to determine the prevalence of onychomycosis, and the diversity and species composition of fungal etiological agents. Materials and Methods: A clinic-based, prospective, non-randomized cross-sectional study was carried out between October 2018 and June 2019 at Rank Higher Specialized Dermatology Clinic, Addis Ababa, Ethiopia. Nail scrapings were collected aseptically from 200 patients clinically identified with nail disorders of fungal origin by dermatologists. Fungal etiological agents were identified microscopically and by culture method following standard procedures. Results: Among 200 nail scrapings, 161 (80.5%) samples were found out to be culture positive. Of these, 135 (83.9%) samples yielded single colonies while 26 (16.1%) mixed colonies gave a total of 190 isolates. Among the isolates, 25.8% were dermatophytes while 61.1% were nondermatophytes molds, and 13.1% were yeasts. Females were more likely to present dystrophic nails than men. Patients in the middle age group were more affected. Trichophyton interdigitale, Aspergillus spp, and Candida albicans were the dominant species. Conclusion: The prevalence rate of onychomycosis in the present study was high. The isolation rate of non-dermatophyte molds was higher than dermatophytes and yeasts. Trichophyton interdigitale, Aspergillus spp, and Candida albicans were the dominant etiological agents. Females and patients in the middle age group were more affected. An increase in the prevalence of non-dermatophyte molds in nail infections dictates further investigation demonstrating how this group of fungi causes onychomycosis.

Background: Early detection of extended-spectrum β-lactamases (ESBLs) producing bacteria is critical for infection prevention and control. Numerous phenotypic approaches and automated systems have been developed for detecting ESBL bacteria. However, there is a scarcity of data in Ethiopia regarding the most reliable, simple, and cost-effective methods for detecting ESBL-producing bacteria. This study, therefore, aimed to evaluate the diagnostic performance of three phenotypic approaches for detecting ESBL-producing bacteria. Methods: In this study, 117 isolates of Klebsiella pneumoniae, Escherichia coli, Klebsiella oxytoca, and Proteus mirabilis were examined. Cefotaxime (30 µg) and ceftazidime (30 µg) were used for screening ESBL enzymes. A screening breakpoints of≤27 mm and≤22 mm were used for cefotaxime (30 µg) and ceftazidime (30 µg), respectively, as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. All 117 strains were further confirmed by the Vitek 2 compact, double disk synergy, ESBL Epsilometer test, and combined disk method. The combined disk method was adopted as the reference method. Results: Out of 117 isolates, 90 (86%) had zone diameters of≤27 mm and≤22 mm for cefotaxime (30 µg) and ceftazidime (30 µg), respectively. The reference method detected 76 (65%) ESBL isolates out of 117 ones. From among the three techniques (i.e., double disk synergy, Vitek 2 compact, and ESBL Epsilometer test), the double disk synergy method demonstrated overall sensitivity and specificity of 97.4% and 97.6%, respectively. Vitek-2, cefotaxime, and ceftazidime Epsilometer test indicated indeterminate results of 6.8%, 6.8%, and 5.1% respectively. Conclusion: Double disk synergy was found to have the highest sensitivity and specificity for detecting ESBL isolates with no indeterminate results.

Background: Onychomycosis is a common refractory fungal infection associated with significant morbidity. The objective of this study was to determine the prevalence of onychomycosis, and the diversity and species composition of fungal etiological agents. Materials and Methods: A clinic-based, prospective, non-randomized cross-sectional study was carried out between October 2018 and June 2019 at Rank Higher Specialized Dermatology Clinic, Addis Ababa, Ethiopia. Nail scrapings were collected aseptically from 200 patients clinically identified with nail disorders of fungal origin by dermatologists. Fungal etiological agents were identified microscopically and by culture method following standard procedures. Results: Among 200 nail scrapings, 161 (80.5%) samples were found out to be culture positive. Of these, 135 (83.9%) samples yielded single colonies while 26 (16.1%) mixed colonies gave a total of 190 isolates. Among the isolates, 25.8% were dermatophytes while 61.1% were non- dermatophytes molds, and 13.1% were yeasts. Females were more likely to present dystrophic nails than men. Patients in the middle age group were more affected. Trichophyton interdigitale, Aspergillus spp, and Candida albicans were the dominant species. Conclusion: The prevalence rate of onychomycosis in the present study was high. The isolation rate of non-dermatophyte molds was higher than dermatophytes and yeasts. Trichophyton interdigitale, Aspergillus spp, and Candida albicans were the dominant etiological agents. Females and patients in the middle age group were more affected. An increase in the prevalence of non-dermatophyte molds in nail infections dictates further investigation demonstrating how this group of fungi causes onychomycosis.

Background There is limited information on the performance of the Xpert® MTB/RIF test for diagnosis of smear-negative pulmonary tuberculosis (SNPT) and rifampicin resistance (RR) in the same-day diagnosis approach. The effects of sputum quality and other factors affecting the Xpert performance are also under-investigated. Objective This study aimed to determine the performance of the Xpert® MTB/RIF test for detection of SNPT and RR in the same-day diagnosis strategy and the effect of sputum quality and other factors on its performance. Methods A cross-sectional study was conducted from August 2017 to January 2018 across 16 health facilities in Addis Ababa, Ethiopia. Two spot sputum samples were collected from 418 presumptive SNPT patients, tested with Xpert® MTB/RIF, then compared to tuberculosis culture. Additionally, culture isolates were tested for RR by BACTEC MGIT™ 960 drug susceptibility testing (DST) and MTBDRplus version 2. Results The Xpert® MTB/RIF test detected 24 (5.7%) SNPT cases, with a sensitivity of 92.3% (75.9% – 97.9%) and specificity of 99.2% (97.8% – 99.7%) compared with tuberculosis culture. Xpert® MTB/RIF also detected three (11.58%) RR strains with 100.0% concordance with BACTEC MGIT™ 960 DST and MTBDRplus results. Three blood-stained SNPT samples were positive by Xpert (30.0%), which was 6.9 times higher compared to salivary sputum (odds ratio: 6.9, 95% confidence interval: 1.36–34.96, p = 0.020). Conclusion The performance of the Xpert® MTB/RIF to detect SNPT and RR in same-day diagnosis is high. However, SNPT positivity varies among sputum qualities, and good sample collection is necessary for better test performance.

The high prevalence of morbidity and mortality from bacterial infections, together with the growing threat of antibacterial resistance, necessitated the development of alternative new drugs from traditional medicine. In Ethiopia, Impatiens tinctoria A. Rich has been traditionally used for the treatment of fungal infections such as ringworms that cause tinea pedis and it have also different medical values. Scientific information on its biological activity against a broad range of bacteria and safety data is scant, compared to its folklore data. In this study, we evaluated antibacterial activities and acute oral toxicity of aqueous, ethanol and ethyl acetate root extracts of Impatiens tinctoria A. Rich. Aqueous, ethanol and ethyl acetate extracts of the plant were evaluated using agar hole diffusion and agar dilution methods. Biological activities of the plant extracts were expressed as a zone of inhibition diameter, minimum inhibitory concentration (mg/ml), and minimum bactericidal concentration (mg/ml). The safety studies were performed by oral acute toxicity study according to the organization of economic cooperation and development test Guidelines 420.Gram-positive bacteria were more susceptible to the extracts compared to gram-negative bacteria, especially against S. aureus and S. epidermidis, which are commonly found in the skin. Ethyl acetate extract was more potent than ethanol and aqueous extracts. The 50% lethal dose (LD50) of tested mice was above 9600 mg/kg. This study provides a scientific basis for the antibacterial activity of the root extracts of I. tinctoria A. Rich, where, the ethyl acetate extract showed the most promising activity. Therefore, the antibacterial potential and practical non-toxicity of the study plant extracts suggested the possibility of using it for the development of antimicrobial drugs by further studying the plant in different directions.

Background. A corneal ulcer is a major cause of monocular blindness in developing countries, including Ethiopia. Its etiology varies based on its geographical location and climatic conditions. Therefore, the main objective of this research was to assess the clinical and microbiological profile of suspected bacterial and fungal corneal ulcers at the Tertiary Eye Care and Training Centre at Gondar University. Methods. A cross-sectional hospital-based study of corneal ulcer cases was performed from February to October 2019. Sociodemographic and clinical data were collected using a standardized questionnaire. Corneal scrapings were used to classify bacterial and fungal pathogens. The specimens were inoculated on BHI media and sub-cultured on culture media for the separate cultivation of bacteria and fungi. Biochemical tests have been carried out to classify bacteria. Following CLSI, the antimicrobial resistance pattern of bacterial isolates was carried out. Wet mounting, Lactophenol cotton blue staining, and colony characteristics on SDA were used to classify fungal species. The data were analyzed with version 20 of the SPSS. Results. A total of 30 suspected bacterial and fungal keratitis patients have been enrolled in this study. The visual acuity presented in 90% of the affected eyes was in the category of blindness (<3/60). In 71% of the cases, clinically presumed risk factors were identified. Trauma was the most common risk factor found in 46% of cases, followed by keratitis exposure (13%). Of the corneal scrape tests, 76.6% were positive for bacteria and fungi. Fungi were identified in 53.3% of corneal ulcers followed by 33.3% of bacterial growth. The commonest fungi and bacteria isolated were Aspergillus species (69%) and S. aureus, respectively. The prevalence of Methicillin-resistant S. aureus (MRSA) was 2 (40%). The identified Pseudomonas species were susceptible to Gentamicin and Ciprofloxacin but resistant to Ceftriaxone. Conclusion. The primary microbial agents for corneal ulcers were fungi, and trauma was the most significant risk factor associated with corneal ulcers. To avoid chronic ocular morbidity and blindness, early identification of the etiologic agent and the provision of adequate management are recommended.

BACKGROUND:Multidrug resistant, extremely drug-resistant, pan-drug resistant, carbapenem-resistant, and carbapenemase-producing gram-negative bacteria are becoming more common in health care settings and are posing a growing threat to public health.OBJECTIVE:The study was aimed to detect and phenotypically characterize carbapenem no- susceptible gram-negative bacilli at the Ethiopian Public Health Institute.MATERIALS AND METHODS:A prospective cross-sectional study was conducted from June 30, 2019, to May 30, 2020, at the national reference laboratory of the Ethiopian Public Health Institute. Clinical samples were collected, inoculated, and incubated for each sample in accordance with standard protocol. Antimicrobial susceptibility testing was conducted using Kirby-Bauer disk diffusion method. Identification was done using the traditional biochemical method. Multidrug-resistant and extensively drug-resistant isolates were classified using a standardized definition established by the European Centre for Disease Prevention and Control and the United States Centers for Disease Prevention and Control. Gram-negative organisms with reduced susceptibility to carbapenem antibiotics were considered candidate carbapenemase producers and subjected to modified carbapenem inactivation and simplified carbapenem inactivation methods. Meropenem with EDTA was used to differentiate metallo-β-lactamase (MBL) from serine carbapenemase. Meropenem (MRP)/meropenem + phenylboronic acid (MBO) were used to differentiate Klebsiella pneumoniae carbapenemase (KPC) from other serine carbapenemase producing gram-negative organisms.RESULTS:A total of 1,337 clinical specimens were analyzed, of which 429 gram-negative bacterial isolates were recovered. Out of 429 isolates, 319, 74, and 36 were Enterobacterales, Acinetobacter species, and Pseudomonas aeruginosa respectively. In our study, the prevalence of multidrug-resistant, extensively drug-resistant, carbapenemase-producing, and carbapenem nonsusceptible gram-negative bacilli were 45.2%, 7.7%, 5.4%, and 15.4% respectively. Out of 429 isolates, 66 demonstrated reduced susceptibility to the antibiotics meropenem and imipenem. These isolates were tested for carbapenemase production of which 34.8% (23/66) were carbapenemase producers. Out of 23 carbapenemase positive gram-negative bacteria, ten (10) and thirteen (13) were metallo-beta-lactamase and serine carbapenemase respectively. Three of 13 serine carbapenemase positive organisms were Klebsiella pneumoniae carbapenemase.CONCLUSION:This study revealed an alarming level of antimicrobial resistance (AMR), with a high prevalence of multidrug-resistant (MDR) and extremely drug-resistant, carbapenemase-producing gram-negative bacteria, particularly among intensive care unit patients at the health facility level. These findings point to a scenario in which clinical management of infected patients becomes increasingly difficult and necessitates the use of "last-resort" antimicrobials likely exacerbating the magnitude of the global AMR crisis. This mandates robust AMR monitoring and an infection prevention and control program.

Background Blood stream infections are serious infections that usually induce prolongation of hospital stay, morbidity and mortality in several countries including Ethiopia. The aim of this study was to determine bacterial and fungal profile, their drug resistance patterns, and risk factors associated with blood stream infections. Methods A cross sectional study design was conducted from February 23 to June 23, 2020 at Ethiopian public health. A structured questionnaire was used to collect data on socio-demographic factors and clinical conditions. Blood specimens were analyzed using standard microbiological techniques. Antimicrobial susceptibility tests were performed using Kirby–Bauer disc diffusion technique and Vitek compact 2. Simple and multiple logistic regressions were used to assess the potential risk factors. Results A total of 175 pathogens isolated from 346 blood specimens. Of these, 60% Gram-negative bacteria, 30.86% Gram-positive bacteria and 9.14% fungal isolates were identified. Burkholderia cepacia and Coagulase negative staphylococcus were the predominant pathogen among Gram-negative and Gram-positive bacteria respectively. Among fungus, Candida krusei (56.25%) was the most predominant isolate. The highest proportions of antibacterial resistance were observed among 3rd generation cephalosporin and penicillin. Most fungal isolates expressed resistance to fluconazole. Sex (P = 0.007), age (P < 0.001) and use of invasive medical devices (P = 0.003) were identified as risk factors for bacterial blood stream infections. Conclusion The study showed high prevalence of blood stream infection was due to B. cepacia and non- C. albicans spp. This finding alarming ongoing investigation of blood stream infection is important for recognizing future potential preventive strategies including environmental hygiene and management of comorbid medical diseases to reduce the problem.