Evaluation of Enriched Rapid Diagnostic Method for Detection of Vibrio Cholerae and Antibiotic Susceptibility Patterns of Serotypes in Juba, South Sudan
Nyangena, Ontweka Lameck
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The global cholera burden is not precisely known since many of the cases lack proper investigation and documentation systems. More importantly, the situation is exacerbated by defective epidemiological surveillance as well as inadequate diagnostic procedures. Isolation of Vibrio cholerae is critical for disease outbreak confirmation. Rapid diagnostic testing of fecal specimens, on basis of lipopolysaccharide detection of V. cholerae O1 or O139 sub-types may enhance early outbreak detection and surveillance. The gold standard for V. cholerae diagnosis is stool culture, although, it’s not feasible in resource constrained settings since it warrants greater than 24 hours of bacterial isolation. As such, the present investigation aimed at evaluating the enriched rapid diagnostic method for V. cholerae detection while also assessing antimicrobial susceptibility patterns of associated V. cholerae serotypes present in Juba, South Sudan. A cross-sectional laboratory-based experimental study was conducted on 109 consenting participants in Juba, South Sudan. Purposive sampling technique was employed. Stool samples were collected and tested using both conventional and the rapid enriched method (alkaline peptone water; APW), with results obtained being compared to V. cholerae stool cultures (gold standard). On the other hand, V. cholerae sero-typing was undertaken using both polyvalent and monovalent antisera. Additionally, antimicrobial susceptibility testing (AST) was carried out on study samples to determine drug sensitivity profiles. All tests were conducted onsite with exception of cultures and AST which were performed in public health laboratory Juba, South Sudan. Out of 109 stool samples only 31.2 % (n=34) were positive for V. cholerae; Inaba serotype 100 % (n=34). Demographic information revealed that 70.6 % (n=24) of all V. cholerae infections were among males aged (26-30 yrs; 32.4 %). Data on antibiotic susceptibility pattern showed that V. cholerae was most sensitive to ceftriaxone (n=31; 91.2 %). Conversely, V. cholerae demonstrated highest resistance against nalidixic acid (n=34; 100 %). Conclusively, enriched method for detection of V. cholerae exhibited notable diagnostic performance compared to V. cholerae culture (control).Sensitivity for enriched and Culture was 68 % in O1 and 0 % in O139 respectively while specificity for enriched was 100 % in O1 and 99.08 % in O139 and on culture was 100 % in both specificity and sensitivity. Additionally, Inaba serotype of V. cholerae showed highest prevalence amongst subjects attending cholera treatment centers and oral rehydration points in Juba, South Sudan. On the other hand, ceftriaxone displayed highest potency agent against V. cholerae. The study concludes that there was high prevalence of Inaba serotype in the region. The findings also inform selection of ceftriaxone as an effective chemotherapeutic agent against V. cholerae Inaba serotype.