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Nicholaus P Mnyambwa,1 Coline Mahende,1 Amani Wilfred,1 Erica Sandi,1 Nicodem Mgina,2 Clara Lubinza,1 Amos Kahwa,1 Pammla Petrucka,3,4 Sayoki Mfinanga,1,3,5 Esther Ngadaya,1 Godfather Kimaro1 1National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania; 2Central Tuberculosis Reference Laboratory (CTRL), Dar es Salaam, Tanzania; 3School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; 4University of Saskatchewan, Saskatoon, Canada; 5Department of Epidemiology and Statistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaCorrespondence: Nicholaus P MnyambwaNational Institute for Medical Research Muhimbili Research Centre, P. O. Box 447, Dar es Salaam, TanzaniaEmail lodnicho@gmail.comIntroduction: Antimicrobial resistance is one of the biggest threats of modern public health. Although sub-Saharan Africa is highly burdened with infectious diseases, current data on antimicrobial resistance are sparse.Methods: A prospective study was conducted between October 2018 and September 2019 to assess the antibiotic susceptibility patterns of clinical bacterial isolates obtained from four referral hospitals in Tanzania. We used standard media and Kirby-Bauer disc diffusion methods as per Clinical and Laboratory Standards Institute (CLSI) standards.Results: We processed a total of 2620 specimens of which 388 (14.8%) were culture-positive from patients with a median (IQR) age of 28 (12– 44) years. Of the positive cultures, 52.3% (203) were from females. Most collected specimens were ear pus 28.6% (111), urine 24.0% (93), wound pus 20.6% (80), stool 14.9% (58), and blood 8.3% (32). Predominant isolates were S. aureus 28.4% (110), E. coli 15.2% (59), P. aeruginosa 10.6% (41), P. mirabilis 7.0% (27), V. cholerae 01 Ogawa 6.2% (24), Klebsiella spp. 5.2% (20) and Streptococcus spp. 4.6% (18). Generally, the isolates exhibited a high level of resistance to commonly used antibiotics such as Ampicillin, Amoxicillin-Clavulanic acid, Erythromycin, Gentamicin, Tetracycline, Trimethoprim, third-generation Cephalosporins (Ceftriaxone and Ceftazidime), and reserved drugs (Clindamycin and Meropenem). S. aureus isolates were resistant to most of the antibiotics tested; 66.7% were classified as MRSA infections.Conclusion: Antibiotic resistance to commonly prescribed antibiotics was alarmingly high. Our findings emphasize the need for comprehensive national control programs to combat antibiotic resistance.Keywords: antibiotics, antimicrobial resistance, AMR, antibiotic susceptibility testing, methicillin-resistant Staphylococcus aureus, MRSA, bacterial isolates

Chibuike Ibe,1 Nicholaus P Mnyambwa,2,3 Sayoki G Mfinanga2 1Department of Microbiology, Faculty of Biological Sciences, Abia State University, Uturu, Nigeria; 2National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania; 3Alliance for Africa Health and Research (A4A), Dar es Salaam, TanzaniaCorrespondence: Chibuike Ibe, Email c.ibe@abiaistateuniversity.edu.ngAbstract: Emergomycosis is an emerging deadly infectious disease caused primarily by a little-known airborne pathogen Emergomyces africanus, which can cause clinical management challenge especially in patients with advanced HIV disease. This minireview describes Es. africanus as the main cause of emergomycosis in Africa as well as considers contributing factors to the difficulties encountered in managing this infection. Emergomycosis is common in HIV-positive persons with low CD4 lymphocyte count and has an estimated fatality of 50%. The infection exhibits airborne transmission with pulmonary and extrapulmonary manifestations leading to skin lesions. However, the pathogenesis of Es. africanus is still poorly understood. The management of the infection is complicated due to lack of defined diagnostic and therapeutic guidelines. Limited expertise, poor research funding, and lack of awareness and national surveillance are thought to impact the recognition and prioritisation of the infection. These factors may ultimately assign emergomycosis a ‘neglected infection status’ even as it is suspected to be prevalent in more African countries than previously recognised. Increased awareness and integrated and targeted strategies such as mobilising manpower in clinical mycology are of paramount importance in managing emergomycosis in Africa and beyond.Keywords: emergomycosis, Es. africanus, epidemiology, pathogenesis, HIV

Ahmed Gharib Khamis,1 Akwilina Wendelin Mwanri,2 Mbazi Senkoro,3 Katharina Kreppel,4,5 Bassirou Bonfoh,6 Sayoki Godfrey Mfinanga,3 Gideon Kwesigabo1 1Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania; 2Department of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania; 3National Institute for Medical Research, Muhimbili Research Centre, Dar-es-Salaam, Tanzania; 4School of Life Sciences and Bio-Engineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; 5Department of Environmental Health and Ecological Sciences, Ifakara Health Institute, Dar-es-salaam, Tanzania; 6Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’IvoireCorrespondence: Ahmed Gharib Khamis, Email ahmadboycd@gmail.comBackground: Unhealthy dietary patterns have contributed to the increase in metabolic syndromes in Tanzania. This study aimed to examine dietary patterns, nutrient intakes and investigate the association with obesity and high blood pressure among adults in agro-pastoral communities in Monduli district, Tanzania.Methods: We conducted a cross-sectional study involving 283 adults aged from 18 years old. Blood pressure and anthropometry were measured from each participant. Dietary intake was assessed using a validated food frequency questionnaire. Principal component analysis was used to identify types of dietary patterns. Logistic regression model was used to examine the associations.Results: Three types of dietary patterns were identified labeled as maize, beans and dairy; meat based; and fruits and vegetables. Higher intake of carbohydrates was found in maize dietary pattern. Meat dietary pattern was associated with higher intake of calcium and protein. Higher intakes of fiber and vitamin B2 was found in the fruits and vegetables dietary pattern. Participants on the third quartile of the maize pattern had higher odds of abdominal obesity (AOR=2.81; 95% CI: 1.09– 7.26). Participants in the third and fourth quartiles of meat based pattern had increased odds of abdominal obesity by five (AOR=5.03; 95% CI: 2.31– 10) and three folds (AOR=3.07; 95% CI: 1.36– 6.92). Participants in the third quartile of fruits and vegetables dietary pattern have lower odds of general obesity (AOR = 0.25, 95% CI: 0.07, 0.9) and abdominal obesity (AOR = 0.25, 95% CI: 0.09, 0.71). No association between dietary patterns and high blood pressure was observed.Conclusion: Three dietary patterns were identified in agro-pastoral communities. This study suggests that higher adherence to maize, beans and dairy dietary pattern and meat based dietary pattern may increase the risk of general and abdominal obesity. The fruits and vegetables dietary pattern may prevent from obesity. Further investigation is recommended to guide the preventive nutrition interventions.Keywords: dietary pattern, obesity, high blood pressure, maize, dairy, red meat, vegetables, pastoral

Nicholaus Peter Mnyambwa,1,2 Esther S Ngadaya,2 Godfather Kimaro,2 Dong-Jin Kim,1 Rudovick Kazwala,3 Pammla Petrucka,1,4 Sayoki G Mfinanga2 1School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; 2National Institute for Medical Research, Muhimbili Medical Research Center, Dar es Salaam, Tanzania; 3Department of Veterinary Medicine, Sokoine University of Agriculture, Morogoro, Tanzania; 4College of Nursing, University of Saskatchewan, Saskatoon, Canada Abstract: Diagnosis of pulmonary tuberculosis (TB) in technology-limited countries is widely achieved by smear microscopy, which has limited sensitivity and specificity. The frequency and clinical implication of smear-positive but culture-negative among presumptive TB patients remains unclear. A cross-sectional substudy was conducted which aimed to identify the proportion of nontuberculous mycobacteria (NTM) infections among 94 “smear-positive culture-negative” patients diagnosed between January 2013 and June 2016 in selected health facilities in Tanzania. Out of 94 sputa, 25 (26.60%) were GeneXpert® mycobacteria TB positive and 11/94 (11.70%) repeat-culture positive; 5 were Capilia TB-Neo positive and confirmed by GenoType MTBC to be Mycobacterium tuberculosis/Mycobacterium canettii. The remaining 6 Capilia TB-Neo negative samples were genotyped by GenoType® CM/AS, identifying 3 (3.19%) NTM, 2 Gram positive bacteria, and 1 isolate testing negative, together, making a total of 6/94 (6.38%) confirmed false smear-positives. Twenty-eight (29.79%) were confirmed TB cases, while 60 (63.83%) remained unconfirmed cases. Out of 6 (6.38%) patients who were HIV positive, 2 patients were possibly coinfected with mycobacteria. The isolation of NTM and other bacteria among smear-positive culture-negative samples and the presence of over two third of unconfirmed TB cases emphasize the need of both advanced differential TB diagnostic techniques and good clinical laboratory practices to avoid unnecessary administration of anti-TB drugs. Keywords: nontuberculous mycobacteria, pulmonary TB, smear-positive, culture-negative, tuberculosis diagnosis