Cryptosporidium infection is one of the most common causes of parasitic diarrhoea worldwide in cattle and humans. In developing countries, human cryptosporidiosis is most prevalent during early childhood and links between zoonotic infection and animal related activities have been demonstrated. This study investigated the prevalence and species/genotype distribution of Cryptosporidium among children (< 5 years) and calves (< 6 months) living in a rural farming area adjacent to the Kruger National Park in South Africa, where interactions between humans and wild and domestic animals are known to occur. Cryptosporidium oocysts were detected in 8/143 stool samples of children recruited within the hospital system (5.6%; 95% CI 2.4%, 10.7%) and in 2/352 faecal samples of calves (0.6%; 95% CI 0.1%, 2.0%) using the modified Ziehl-Neelsen (MZN) staining technique. Microscopy positive samples from children were further analysed by PCR targeting the 18S rRNA gene and identified as Cryptosporidium hominis (3/4) and Cryptosporidium meleagridis (1/4). Regardless of the microscopy outcome, randomly selected samples (n = 36) from calves 0-4 months of age were amplified and sequenced at the 18S rRNA gene using nested PCR. Two calves tested positive (5.6%; 95% CI 1.7%, 18.7%), and revealed the presence of Cryptosporidium parvum and Cryptosporidium bovis. The detection of only two zoonotic species (C. parvum in one calf and C. meleagridis in one child) suggests that zoonotic cryptosporidiosis is not currently widespread in our study area; however, the potential exists for amplification of transmission in an immunocompromised population.

OBJECTIVE: To describe findings from an external quality assessment programme involving laboratories in Africa that routinely investigate epidemic-prone diseases. METHODS: Beginning in 2002, the Regional Office for Africa of the World Health Organization (WHO) invited national public health laboratories and related facilities in Africa to participate in the programme. Three surveys comprising specimens and questionnaires associated with bacterial enteric diseases, bacterial meningitis, plague, tuberculosis and malaria were sent annually to test participants' diagnostic proficiency. Identical surveys were sent to referee laboratories for quality control. Materials were prepared, packaged and shipped in accordance with standard protocols. Findings and reports were due within 30 days. Key methodological decisions and test results were categorized as acceptable or unacceptable on the basis of consensus feedback from referees, using established grading schemes. FINDINGS: Between 2002 and 2009, participation increased from 30 to 48 Member States of the WHO and from 39 to 78 laboratories. Each survey was returned by 64-93% of participants. Mean turnaround time was 25.9 days. For bacterial enteric diseases and meningitis components, bacterial identification was acceptable in 65% and 69% of challenges, respectively, but serotyping and antibiotic susceptibility testing and reporting were frequently unacceptable. Microscopy was acceptable for 73% of plague challenges. Tuberculosis microscopy was satisfactorily performed, with 87% of responses receiving acceptable scores. In the malaria component, 82% of responses received acceptable scores for species identification but only 51% of parasite quantitation scores were acceptable. CONCLUSION: The external quality assessment programme consistently identified certain functional deficiencies requiring strengthening that were present in African public health microbiology laboratories.

OBJETIVO: Describir los resultados de un programa de evaluación externa de la calidad de los laboratorios africanos que investigan habitualmente las enfermedades con tendencia a provocar epidemias. MÉTODOS: En el año 2002, la Oficina Regional para África de la Organización Mundial de la Salud (OMS) invitó a los laboratorios nacionales de la sanidad pública así como a los centros relacionados de África a participar en el programa. Con el fin de comprobar la capacidad de diagnóstico de los participantes, se les enviaron anualmente tres encuestas con muestras y cuestionarios relacionados con enfermedades enterobacterianas, meningitis bacteriana, peste, tuberculosis y malaria. Con el fin de realizar un control de calidad, se enviaron las mismas encuestas a los laboratorios evaluadores. Los materiales se prepararon, empaquetaron y enviaron de acuerdo con los protocolos estándar. Los resultados y las encuestas debían estar listos en un plazo de 30 días. Las principales decisiones metodológicas y los resultados de las pruebas se clasificaron como aceptables o inaceptables en base a la respuesta consensuada de los evaluadores por medio de los programas de calificación establecidos. RESULTADOS: La participación aumentó desde 30 hasta 48 Estados Miembros de la OMS y desde 39 hasta 78 laboratorios entre los años 2002 y 2009. Entre un 64 y un 93% de los participantes remitieron cada una de las encuestas y el plazo medio de entrega fue de 25,9 días. En los casos de enfermedades enterobacterianas y de meningitis, la identificación bacteriana fue aceptable en un 65% y un 69% de los casos, respectivamente, si bien las pruebas y los resultados de serotipado y de sensibilidad a los antibióticos fueron, con frecuencia, inaceptables. La microscopía resultó aceptable en el 73% de las pruebas de peste. La microscopía de tuberculosis se realizó de manera satisfactoria: un 87% de las respuestas obtuvo resultados aceptables. En el componente de la malaria, un 82% de las respuestas obtuvieron puntuaciones aceptables en cuanto a la identificación de la especie, pero solo el 51% de las puntuaciones para la cuantificación de parásitos resultó aceptable. CONCLUSIÓN: El programa de evaluación externa de la calidad identificó de manera sistemática algunas deficiencias funcionales que

OBJECTIF: Décrire les résultats d'un programme d'évaluation externe de la qualité impliquant des laboratoires africains étudiant de matière systématique les maladies à potentiel épidémique. MÉTHODES: Dès 2002, le Bureau régional pour l'Afrique de l'Organisation mondiale de la Santé (OMS) a invité les laboratoires de santé publique nationaux et des installations connexes en Afrique à participer au programme. Trois études comprenant des échantillons et des questionnaires associés aux maladies entériques bactériennes, à la méningite bactérienne, à la peste, à la tuberculose et au paludisme ont été envoyés chaque année pour tester la qualité du diagnostic des participants. Des études identiques ont été envoyées à des laboratoires arbitres pour le contrôle de la qualité. Les matériaux ont été préparés, emballés et expédiés conformément aux protocoles standard. Les résultats et les rapports devaient parvenir dans les 30 jours. Les principales décisions méthodologiques et les résultats des tests ont été qualifiés d'acceptables ou d'inacceptables, sur la base des commentaires consensuels des arbitres, utilisant des schémas de notation établis. RÉSULTATS: Entre 2002 et 2009, la participation est passée de 30 à 48 États membres de l'OMS, et de 39 à 78 laboratoires. Chaque étude a été renvoyée par 64 à 93% des participants. Le délai moyen était de 25,9 jours. Pour les maladies entériques bactériennes et les composants de la méningite, l'identification bactérienne était acceptable dans 65% et 69% des tests, respectivement, mais le sérotypage et les tests de sensibilité aux antibiotiques, ainsi que les rapports, étaient souvent inacceptables. La microscopie était acceptable dans 73% des tests de peste. La microscopie de la tuberculose était effectuée de manière satisfaisante, 87% des réponses obtenant des scores acceptables. Dans la composante paludisme, 82% des réponses ont obtenu des scores acceptables pour l'identification des espèces, mais seuls 51% des scores de quantification des parasites étaient acceptables. CONCLUSION: Le programme externe d'évaluation de la qualité a identifié de manière constante certaines déficiences fonctionnelles nécessitant une amélioration, dans les laboratoires de microbiologie du système de santé publique africain.

Bartonellae are highly adaptive organisms that have the ability to evade the host immune system and cause persistent bacteraemia by occupying the host's erythrocytes. Bartonella spp. is under-studied and health care professionals often misdiagnose Bartonella-related infections. The aim of this study was to investigate the carriage of Bartonella spp. circulating in human and animal populations in Gauteng using culturing and polymerase chain reaction (PCR) detection. A total of 424 human, 98 cat, 179 dog, and 124 wild rodent blood samples were plated onto specialised media and incubated for 7-21 days at 37 °C in CO2. Culture isolates morphologically similar to Bartonella control strains were confirmed by PCR and sequenced to determine species. Deoxyribonucleic acid (DNA) was extracted from all blood samples and tested by nested PCR. Bartonella could only be cultured from the cat and rodent specimens. Cat isolates were > 99% similar to Bartonella henselae URBHLIE 9, previously isolated from an endocarditis patient, and rat isolates were > 98% similar to either RN24BJ (candidus 'Bartonella thailandensis') or RN28BJ, previously isolated from rodents in China. The PCR prevalences were 22.5% in HIV-positive patients, 9.5% in clinically healthy volunteers, 23.5% in cats, 9% in dogs and 25% in rodents. Findings of this study have important implications for HIV-positive patients.

BACKGROUND: Malaria rapid diagnostic tests (MRDTs) are quick and easy to perform and useful for diagnosing malaria in primary health care settings. In South Africa most malaria infections are due to Plasmodium falciparum, and HRPII-based MRDTs have been used since 2001. Previous studies in Africa showed variability in sensitivity and specificity of HRPIIbased MRDTs; hence, we conducted a field evaluation in Limpopo province to determine the accuracy of the MRDT currently used in public sector clinics and hospitals. METHODS: A cross-sectional observational study was conducted to determine the sensitivity and specificity of an ICT Pf MRDT. We tested 405 patients with fever with ICT Pf MRDT and compared the results with blood film microscopy (the gold standard). RESULTS: The overall sensitivity of the ICT Pf MRDT was 99.48% (95% confidence interval (CI) 96.17 - 100%), while specificity was 96.26% (95% CI 94.7 - 100%). The positive predictive value of the test was 98.48 (99% CI 98.41 - 100%), and the negative predictive value was 99.52% (95% CI 96.47 - 100%). CONCLUSIONS: The ICT Pf MRDT is an appropriate test to use in the field in South Africa where laboratory facilities are not available. It has a high degree of sensitivity and acceptable level of specificity in accordance with the World Health Organization criteria. However, sensitivity of MRDT at low levels of parasitaemia (<100 parasites/µl of blood) in field conditions must still be established.