AimsTo identify the Candida species that cause vulvovaginal candidiasis and determine their antifungal susceptibility patterns.Study DesignThis was a cross-sectional study.Place and Duration of StudyThe study was conducted at the antenatal clinic of Mbarara Regional Referral Hospital in Mbarara Municipality, between December 2012 and February 2013.MethodsHigh vaginal swabs from 456 pregnant women were subjected to microscopy and culture on Sabouraud Dextrose Agar. Candida isolates were identified by the germ tube and Analytical profile index (API® Candida) tests. Susceptibility to fluconazole, itraconazole and voriconazole was determined by the Etest strips and for clotrimazole and nystatin by the disc diffusion method on Mueller Hinton agar supplemented with 2%w/v glucose and 0.5μg/ml methylene blue dye.ResultsOf the 456 High vaginal swabs cultured, 207 grew Candida species. Species distribution was as follows: C. albicans (78.95%), C. glabrata (14.35%), C. krusei (3.35%), C. tropicalis (1.44%), C. famata (0.96%), C. parapsilosis (0.48%) and C. lusitaniae (0.48%). Resistance to nystatin was only observed in 0.61% of C.albicans. Resistance to clotrimazole was observed in 50%, 36.67% and 0.61% of C. famata, C. glabrata and C. albicans respectively. C. krusei showed a high resistance of 71.43% to fluconazole. C. glabrata, C. krusei, C. famata and C. lusitaniae exhibited 100% resistance to itraconazole. Resistance to voriconazole of less than 11% was exhibited by only C. albicans and C. glabrata.ConclusionC.albicans was susceptible to most antifungal agents tested except itraconazole and voriconazole. All isolates were susceptible to nystatin except less than 1% of Candida albicans. Non-albicans demonstrated resistance to some drugs especially itraconazole. We recommend use of Nystatin for empirical management of vulvovaginal candidiasis among pregnant women.

A bacterial endosymbiont of the fungus Rhizopus microsporus drives phagocyte evasion and opportunistic virulence Highlights d Bacterial endosymbionts protect fungal spores from phagocytes d A secreted factor blocks growth and killing by environmental amoebas d Endosymbionts improve fungal stress resistance d Endosymbiosis also allows the evasion of vertebrate immune cells and virulence in vivo

Aim To characterize AmpC-beta lactamases among Enterobacteriaceae isolates from clinical samples at Mbarara Regional Referral Hospital. Study Design Laboratory-based descriptive cross-sectional study Place and Duration of Study Microbiology Department, Mbarara Regional Referral Hospital and MBN clinical Laboratories, between May to September 2013. Methodology This study included 293 Enterobacteriaceae isolates recovered from clinical specimens that included blood, urine, stool and aspirates. AmpC Beta lactamase production was determined using disc placement method for cefoxitin at a break point of <18mm. Common AmpC plasmid mediated genes were EBC, ACC, FOX, DHA, CIT and MOX were; was determined by Multiplex PCR as described by Hanson and Perez-Perez. Results Plasmid mediated AmpC phenotype was confirmed in 107 of the 293 (36.5%) cefoxitin resistant isolates with 30 isolates having more than one gene coding for resistance. The commonest source that harbored AmpC beta lactamases was urine and E. coli was the most common AmpC producer (59.5%). The genotypes detected in this study, included EBC (n=36), FOX (n=18), ACC (n=11), CIT (n=10), DHA (n=07) and MOX (n=1). Conclusion Our findings showed that prevalence of AmpC beta-lactamase at MRRH was high (39.6), with EBC as the commonest genotype among Enterobacteriaceae Urine and E. coli were the commonest source and organism respectively that harbored AmpC beta-lactamases. There‘s rational antimicrobial therapy and antibiotic susceptibility tests should be requested by health workers especially patients presenting with urinary tract infections and bacteraemias.

AimsThe study was conducted to determine the prevalence of Clindamycin (CL) resistance and antimicrobial susceptibility among clinical isolates of Staphylococcus aureus (S. aureus) from Mbarara Regional Referral Hospital (MRRH) in Southwestern Uganda.Study DesignLaboratory based cross sectional study.Place and Duration of the StudyThe study was conducted at the Microbiology department of Mbarara Regional referral hospital between November 2012 and December 2013.MethodologyIn our study, we recruited 300 S. aureus isolates that were stored in the laboratory and were obtained from different clinical samples. The isolates were tested for antimicrobial susceptibility by phenotypic methods and for the genotypic expression of Macrolide Lincosamide StreptograminB (MLSB) resistance genes (ermA, ermB, ermC, and msrA). The D-test was also performed.ResultsPhenotypically, a total of 109 (36%) S. aureus isolates were resistant to CL, of which 9 (3%) were constitutively resistant while 100 (33.3%) were inducibly resistant. Genotypicaly, 134/300 (44.7%) isolates possessed at least one of the MLSB resistance genes. 23/300 (7.7%) tested positive for ermB, 98/300 (32.7%) tested positive for the ermC and 43/300 (14.3%) tested positive for the msrA genes with none possessing the ermA gene. Isolates were highly resistant to Sulfamethoxazole/trimethoprim, Erythromycin and Oxacillin with moderate resistance to Vancomycin and Imipenem and least resistance to LinezolidConclusionS. aureus resistance to CL was high in this set up. There was also high resistance to Sulfamethoxazole/trimethoprim, Erythromycin and Oxacillin but low resistance to Linezolid.

Mucorales spores, the causative agents of mucormycosis, interact with the innate immune system to cause acute, chronic, or resolving infection. Understanding the factors that influence disease initiation and progression is key to understanding mucormycosis and developing new treatments. Complicating this, mucormycosis can be caused by a number of species that span the Mucorales genus and may be host to bacterial endosymbionts. This study sets out to examine the differences between two species in the Mucorales order by characterising their differential interactions with the innate immune system, and their interactions with environmental bacterial endosymbionts. Through a holistic approach, this study examines the transcriptional responses ofRhizopus delemarandRhizopus microsporus,two of the most commonly diagnosed species, to innate immune cells. This study also examines the immune cell response and assesses the variation in these responses, given the presence or absence of bacterial endosymbionts within the fungi. We see that the fungal response is driven by interaction with innate immune cells. The effect of the bacterial endosymbiont on the fungus is species specific, with a minimal in the absence of stress, but strongly influencing fungal transcripts during interaction with innate immune cells. In contrast, we observe that the macrophage response varies depending on the infecting fungal species, but also depending on endosymbiont status. The most successful macrophages elicit a pro-inflammatory response, and we see that through germination inhibition macrophage survival is enhanced. This work reveals species-specific host responses to related Mucorales spores and shows that bacterial endosymbionts impact the innate immune cell response.