José Sumbana

Globally, antibiotic-resistant Klebsiella spp. cause healthcare-associated infections with high mortality rates, and the rise of hypervirulent Klebsiella pneumoniae (hvKp) poses a significant threat to human health linked to community-acquired infections and increasing non-susceptibility. We investigated the phenotypic and genetic features of 36 Klebsiella isolates recovered from invasive infections at Hospital Central of Maputo in Mozambique during one year. The majority of the isolates displayed multidrug resistance (MDR) (29/36) to cephalosporins, gentamicin, ciprofloxacin, and trimethoprim–sulfamethoxazole but retained susceptibility to amikacin, carbapenems, and colistin. Most isolates were ESBLs-producing (28/36), predominantly carrying the bla_CTX-M-15 and other beta-lactamase genes (bla_SHV, bla_TEM-1, and bla_OXA-1). Among the 16 genomes sequenced, multiple resistance genes from different antibiotic classes were identified, with bla_CTX-M-15, mostly in the ISEcp1-bla_CTX-M-15-orf477 genetic environment, co-existing with bla_TEM-1 and aac(3)-IIa in five isolates. Our results highlight the presence of polyclonal MDR ESBL-producing K. pneumoniae from eight sequence types (ST), mostly harbouring distinct yersiniabactin within the conjugative integrative element (ICE). Further, we identified susceptible hvKp ST23, O1-K1-type isolates carrying yersiniabactin (ybt1/ICEKp10), colibactin, salmochelin, aerobactin, and hypermucoid locus (rmpADC), associated with severe infections in humans. These findings are worrying and underline the importance of implementing surveillance strategies to avoid the risk of the emergence of the most threatening MDR hvKp.

Water microbial contamination is one of the major threats to human health. The study focus is on Infulene River Basin, a urban catchment with mainly informal settlements, with limited water supply and sanitation. In the catchment there are two wastewater treatment plants, one hospital and beer factory located on the banks of the main stream; water from this stream is used for urban agriculture and domestic uses by some dwellers. These factors present a significant health risk from water-borne diseases. At the moment there is limited knowledge about the level of microbial contamination of the different sources of water at the disposal of the communities. Thus, a preliminary study on fecal microbial contamination was conducted targeting the Infulene River and the drainage system from the nearby Maputo city draining into the system, with additional investigation on the drinking water provided by the city water supply company. The quantification of Total Coliforms (TC) and Escherichia coli (EC) was conducted at several sampling locations. Results were compared with official drinking water standards. Eighty two percent (82%) and 61% of Infulene river water and drainage water samples were positive for TC (10⁵ to 10⁹ NPN/100 mL) and EC (10⁵ to 10⁷ NPN/100 mL), respectively. For drinking water samples, 63% and 23% were positive for TC (up to 6000 NPN/100 mL) and EC (up to 1000 NPN/100 mL), respectively. Higher microbial contamination was found in neighborhoods with the poorest sanitation and shallow groundwater, i.e., Chamanculo, Xipamanine, Mafalala, Aeroporto and Maxaquene, a situation that was more expressive during the rainy season. Overall, the study confirmed the high vulnerability to microbial contamination of all sources investigated due to poor sanitation and lack of drainage infrastructure. The risks to human health might be even higher considering that contaminated water is used for gardening of vegetable watering and domestic use.

Enterobacter spp. are important nosocomial pathogens responsible of a wide variety of infections, mainly due to Extended Spectrum β-Lactamase (ESBL) producing isolates, constituting a global public health issue in terms of clinical treatment and infection control, especially in low-income countries, where last-line treatment is often unavailable and there is weak nosocomial surveillance. In this study, we conducted a phenotypic and molecular characterization of 8 clinical Enterobacter spp. strains, isolated from patient’s blood in three hospitals in Mozambique. Isolates were identified by MALDI-TOF and antimicrobial Susceptibility Testing was performed by VITEK 2 system. Half of isolates were analyzed by PCR for β-lactamases genes, other isolates by Whole Genome Sequencing. We identified all isolates as Enterobacter cloacae complex (ECC), those from Maputo Central Hospital were polyclonal, multidrug resistant (5/8), and ESBL producers (50%), carrying bla_CTX-M-15 and different assortment of bla_SHV-12, bla_TEM-1B and bla_OXA-1, and AmpCs bla_CMH-3, bla_ACT-7 and bla_ACT-9 genes. Resistance determinants linked to fluoroquinolone (aac(6')Ib-cr and qnrB1) and others antimicrobials were also found. Notably, one isolate showed phenotypically resistance to colistin, while another colistin susceptible isolate carried a silent mcr-9 gene. ECC nosocomial surveillance is urgently needed to contain and prevent the dissemination of ESBLs producing clones, and mcr-9 spread to other Enterobacteriaceae.

Introduction: The novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), etiological agent of coronavirus disease 2019 (COVID-19) was first reported in China in December 2019 and spread worldwide. As of March 6^th, 2021, there have been 116,670,105 million confirmed cases globally including 2,592,085 deaths. COVID-19 cases have been reported in 219 countries and territories, creating global panic. Mozambique has witnessed the evolution of COVID-19 epidemic associated with the weakness of health system, mostly in terms of laboratory diagnosis capacity, concerns on compliance to effective public health measures including physical distancing, use of masks in crowded indoor areas, hand hygiene, isolation and quarantine of people. Methodology: The data included in this study were collected from published articles regarding COVID-19 imported cases and severity in Africa, especially in Mozambique. Additionally, official documents of COVID-19 epidemiology from Minister of Health and National Institute of Health of Mozambique from 22^nd of March 2020 to 1^st of August 2020 were included. Results: The SARS-CoV-2 strains imported mainly from South Africa and European countries might have been playing an important role on COVID-19 epidemic evolution in Mozambique. Conclusions: These circulating strains in the country, might be similar enough to the strains found in other countries, yet the genomic characterization is needed particularly during the phase of borders reopening through understanding the source of infections and guiding the implementation of containment and mitigation measures in the country.

Mozambique is located on the East Coast of Africa and was one of the last countries affected by COVID-19. The first case was reported on 22 March 2020 and since then the cases have increased gradually as they have in other countries worldwide. Environmental and population characteristics have been analyzed worldwide to understand their possible association with COVID-19. This article seeks to highlight the evolution and the possible contribution of risk factors for COVID-19 severity according to the available data in Mozambique. The available data highlight that COVID-19 severity can be magnified mainly by hypertension, obesity, cancer, asthma, HIV/SIDA and malnutrition conditions, and buffered by age (youthful population). Due to COVID-19 epidemic evolution, particularly in Cabo Delgado, there is the need to increase laboratory diagnosis capacity and monitor compliance of preventive measures. Particular attention should be given to Cabo Delgado, including its isolation from other provinces, to overcome local transmission and the spread of SARS-CoV-2.