RNA-Seq reveals strain-specific immune gene expression by epithelial cells infected with Mycobacterium tuberculosis strains of varying pathogenicity

Abstract

Background: Sepsis isone of the major predictor of death in patients with visceral leishmaniasis(VL).However, there are currently no reliable data available on bacterial sepsis in VL patients in Ethiopia. This study aimed to assess the prevalence of bacterial sepsis, causative agents and their antimicrobial susceptibility patterns and focus of infection in patients with VL. Methods & Materials: A prospective cross sectional study was conducted among parasitologically confirmed VL patients suspected of sepsis admitted to University of Gondar Hospital, Northwest Ethiopia from February 2012 to May 2012.Sociodemographic characteristics and clinical manifestations were documented after patient interview and physical examination. Samples (blood, urine and others as indicated) were collected and culturedusing standard methods.Isolates were tested for antimicrobial susceptibility using the disc diffusionmethod.Data were entered and analyzed using SPSS version 20. Results: Most of the patients 81 (97.6%), 67 (80.7%), 75 (90.4%), 80 (96.4%) were febrile, tachycardic, tachypnic, and leukopenic, respectively. The prevalence of culture confirmed bacterial sepsis was 19.3% (16/83). The most frequently isolated organism was Staphylococcus aureus, accounting for 11/16 (68.8%) of cases. There was a concordance rate of 11/12 (91.6%) between bacterial isolates and their susceptibility pattern between focal infections and blood stream infections. The overall multiple resistance was 13/16 (81.3%). The highest rate of resistance was for ampicillin 11/11 (100%), and two were MRSA. Vancomycin, gentamicin and ceftriaxone were found to be effective against most isolates. Focal bacterial infection was showed significant association with bacterial sepsis (P =0.00; Odds ratio =11.65; 95% confidence interval 4.29-31.60). Factors such as sex, age, HIV status, 72 hour hospital staywere not associatedwith bacterial sepsis. Conclusion: The prevalence of culture confirmed bacterial sepsis was high, multiple drug resistant Staphylococcus aureus being the frequent isolate. Focal bacterial infections are potential sources for bacterial sepsis among VL patients. Therefore, clinicians should give emphasis to treat VL patients with focal bacterial infection before developing to sepsis. Rational use of antibiotics should be practiced in order tominimize the spread of drug resistant bacteria.