Resistance to a last-resort antibiotic in an already multidrug-resistant (MDR) bacterial pathogen is concerningly high in Africa, according to a study published last week in JAC-Antimicrobial Resistance.

In a systematic review and meta-analysis, researchers from Woldia University in Ethiopia examined data from 30 studies that reported on colistin resistance in clinical specimens of MDR Klebsiella pneumoniae collected from hospitals in Africa. With mortality rates ranging from 40% to 70%, MDR K pneumoniae has been identified as a high-priority global health threat by the World Health Organization. Colistin is one of the few remaining options for treating MDR K pneumoniae infections.

"Colistin resistance in K. pneumoniae is often associated with high morbidity and mortality, especially in critically ill patients, and its spread poses a serious challenge to treatment options across the African continent," the study authors wrote.

Highest levels of colistin resistance found in East Africa

The 30 studies covered 11 African countries: Egypt, Nigeria, South Africa, Uganda, Kenya, the Democratic Republic of the Congo, Algeria, Ethiopia, Mali, Ghana and Mozambique. Nearly half of the reviewed studies (13) were conducted in Egypt. 

The overall pooled prevalence of colistin resistance was 21.6%, with high heterogeneity and significant sub-regional variation. By sub-region, East Africa had the highest pooled prevalence of colistin resistance (42.3%), followed by West Africa (37.1%), Southern Africa (17.1%), and North Africa (13%). By country, colistin resistance was highest in Nigeria (39.1%), Kenya (22.5%), South Africa (17.2%), and Egypt (14%).

Colistin resistance in K. pneumoniae is often associated with high morbidity and mortality, especially in critically ill patients, and its spread poses a serious challenge to treatment options across the African continent.

The authors say the findings support the need for greater regulation of colistin use to maintain its effectiveness.

"Despite the considerable heterogeneity across the included studies and the limited or absent data from some countries, the estimated pooled prevalence provides a valuable indicator of colistin resistance in Africa," they wrote. "Further research is essential, particularly studies focusing on colistin stewardship and improving access to rapid diagnostic tools for detecting colistin resistance across the continent."

Since its last update in May on a Salmonella outbreak linked to pet geckos, the US Centers for Disease Control and Prevention (CDC) last week reported 35 more infections from 16 states and added one more serotype to the outbreak.

Federal officials first announced the outbreak on March 13, when there were just a handful of cases from eight states, all involving Salmonella Muenchen. With the new illnesses, the total now stands at 49 people from 27 states. Of those, 18 infections involve S Muenchen, and 31 involve S Lome. Nine people have been hospitalized, and no deaths have been reported. The latest illness onset was June 12. The median age of the patients is 24 years, and 20% are children younger than 5 years. 

Whole-genome sequencing of samples collected from patients’ homes in California and New York showed that the two serotypes were closely related to the bacteria from sick people.

Multiple gecko types, but crested most common 

Of 37 people asked about animals they were exposed to before they got sick, 19 reported contact with a pet gecko. Of 18 who had information about the type of gecko they had contact with, 12 reported contact with crested geckos, 7 with leopard geckos, and one each with African fat-tailed, Malaysian cat, satanic leaf-tailed, white-lined, and wild geckos.

People bought the geckos from multiple retail locations, and investigators are still gathering information on where people got their pets and what breeders supplies them. However, the outbreak strains have been linked to multiple suppliers, including one common to both outbreak strains.

Salmonella outbreaks have been tied to pet geckos before. For example, a similar outbreak in 2015 sickened 22 people from 17 states, according to CDC data. The CDC urges gecko owners to wash their hands after handing the animals, their food, or items in their environment. Officials also recommend keeping geckos out of the kitchen or anywhere food is prepared and stored and keeping geckos or other reptiles and amphibians away from children younger than 5 who are at higher risk of Salmonella illness complications.

An investigation into long-term health effects in patients infected with the Ebola Sudan virus in an outbreak in Uganda in 2022 and 2023 found persistent clinical symptoms as long as 2 years out, with viral RNA detected in semen and breast milk for up to 7 months after infection. An international team published its findings in a recent issue of BMC Medicine.

Ebola Sudan virus, one of six ebolavirus species and distinct from the Zaire strain that triggered a large outbreak in West Africa and past outbreaks in the Democratic Republic of the Congo (DRC). Ebola Sudan reappeared in Uganda in September 2022 after more than a decade. It was declared over in January 2023 and resulted in 142 confirmed cases, 55 of them fatal.

Using interviews and structured clinical exams, researchers tracked the clinical symptoms of 87 lab-confirmed Ebola Sudan survivors in Uganda over a 2-year period and compared the findings with the same data from 176 age-, sex-, and village-matched controls. Also, using PCR testing, they investigated viral shedding of RNA in semen and breast milk among survivors during the follow-up.

Half had debilitating multisystem symptoms

Frequency of clinician symptoms was 57.4% higher in Ebola survivors, especially musculoskeletal, neurologic, and ophthalmologic. The risk ratio for occurrence was highest for ophthalmologic and central nervous system symptoms and lowest for the reproductive system. Notably, half of the survivors had multisystem symptoms, compared to the control group, that resulted in an inability to perform basic activities of living. 

When the team looked at viral RNA persistence in body fluids, they found traces of the virus in semen for as long as 210 days and as long as 199 days in breast milk, which they said emphasizes the risk of latency and virus reactivation. Ebola is known to persist in immune-protected sites, including the testes and eyes.