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“One Health” is a collaborative, multisectoral, and transdisciplinary approach — working at the local, regional, national, and global levels — with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment” (CDC.gov)
Bacterial infectious diseases are common medical problems in developing countries. Due to limited diagnostic facilities, the causative agents and sources of infection, as well as modes of transmission, often remain unidentified. Empiric treatment is a common practice, fostering the emergence of antibiotic resistance and leading to difficult-to-treat infections. Due to the absence of effective monitoring, knowledge of circulating bacterial strains, their reservoirs and how these change over time, is limited.
Because of our close connection with animals, particularly in developing countries, human infections are often zoonoses. Pathogens can be transmitted to humans through direct contact or through food, water or the environment. Overuse of antibiotics in animal husbandry has significantly contributed to the increase of multidrug resistant bacteria, found both in animals and humans.
Bacteria can also survive for extended periods in the environment. For example, in water, in soil, and of particular concern for human health, in the hospital environment. They are capable of adapting to different environments.
Our research interests cover the generation and comparison of bacteriological data from humans, animals and the environment in countries with limited resources. A special focus is on transmission and the identification of reservoirs of antibiotic resistant bacteria in rural areas of sub-Saharan African countries. Our activities will support and guide patient management and public health measures.
Salmonella enterica cause more than 1.2 million annual deaths worldwide, the majority occurring in resource-limited countries. Infections with nontyphoidal Salmonella (NTS) are typically limited to gastrointestinal disease in industrialized countries. In contrast, in sub-Saharan Africa (SSA), NTS are the most frequent cause of bacterial bloodstream infections in adults and children, associated with high fatality rates. In both industrialized countries and SSA, the serovars Typhimurium and Enteritidis cause the majority of infections. In recent years, Salmonella enterica in SSA have also become increasingly resistant to locally available antibiotics, leading to the substantial burden of NTS infections in Africa.
In industrialised countries, infections with NTS are typically of zoonotic origin with regular food-borne outbreaks. In developing countries, studies on transmission reservoirs are limited but previously it has been found that African Salmonella strains have genetically developed, adapting to different hosts or to the environment.
Our research activities focus on transmission including human, animal and environmental reservoirs, antibiotic resistance and genomic characterisation of circulating Salmonella strains in SSA in order to suggest the implementation of effective control strategies.
Korogwe District hospital, Korogwe, Tanzania
In resource-limited countries, broad-spectrum antibiotics are often prescribed empirically without microbiological diagnosis. This overuse of antibiotics in human medicine, significantly contributes to the emergence and the increase of multidrug resistance. In addition, the use of antibiotics in animal husbandry as growth promoters and for prophylaxis against and for treatment of infection aggravates this problem. In some settings, animal farming is a common occupation, and people live in close proximity to animals. Animals and meat products have been suggested as an important source for drug resistant enteric pathogens including Campylobacter spp., Arcobacter spp., Salmonella enterica, ESBL-producing Escherichia coli and Klebsiella pneumoniae in sub-Saharan Africa (SSA) countries. Transmission might occur by direct contact or consumption of contaminated meat products, leading to the colonization of the intestinal tract and eventually to infections. So far, the degree to which animals play a role as a reservoir for the transmission of multidrug resistant bacteria has not been studied extensively on genotype level in rural areas of SSA. Within this project, Campylobacter spp., Arcobacter spp., Salmonella enterica, ESBL-producing E. coli and K. pneumoniae genomes collected from human and animals will be compared to examine transmission between human and animal in rural areas of Tanzania and Ghana.
Korogwe District hospital, Korogwe, Tanzania
Globally, one in ten child deaths during the first five years of life result from diarrhoeal disease. Due to limitations in diagnostic facilities in resource-constrained clinical settings, the aetiological agent of diarrhoeal disease is rarely laboratory confirmed. In the past years, clinical studies on diarrhoeal diseases in developing countries have shed more light on the predominating causes of infection. Campylobacter spp., Shigella spp., and diarrhoeagenic Escherichia coli and Salmonella enterica have been among the most common pathogens isolated from patients with diarrhoea. So far, studies on Arcobacter spp. are limited. Arcobacter spp. is an emerging pathogen but its role in diarrhoeal disease not well understood. In the past years, moderate associations with diarrhoea have been demonstrated for Shigella spp., Campylobacter spp. and diarrhoeagenic Escherichia coli but the associations on bacterial subtype level have not been studied thoroughly. Data on subtype specific burden of diarrhoea and antibiotic resistance is needed in order to identify populations at risk, to develop preventive measures and to adjust antibiotic usage when treatment is indicated.
Within this study we investigate and compare bacterial subtypes in children below 5 years of age and the association with diarrhoea in a rural hospital in Tanzania.
Korogwe District hospital, Korogwe, Tanzania
Invasive disease with non-typhoidal Salmonella (NTS) in sub-Saharan Africa (SSA) is associated with increasing antibiotic resistance (AMR) and has been classified by the World Health Organization as high priority for developing new antibiotics. Despite high case fatality rates, particularly in children <5 years of age in SSA countries, no vaccine is currently available. The burden caused by NTS infections and increasing AMR strongly advocate for prompt development of an effective vaccine. A novel vaccine, is currently being developed by GSK Biologicals and GSK Vaccines Institute for Global Health, targeting the serovars Typhimurium and Enteritidis, the most common causative agents of African invasive NTS (iNTS). Within a large consortium, a paediatric Phase I/II study will be launched early in 2021 in Ghana. The focus of our group will be on antibiotic resistant genotypes of iNTS-causing Salmonella strains. The study will not only provide information on circulating Salmonella serovars and genotypes, but also on the development of AMR pathogens in SSA.
Molecular Characterization of Staphylococcus aureus isolated from chronic wounds in rural Ghana
Wolters M, Frickmann H, Christner M, Both A, Rohde H, Oppong K, Wiafe Akenten C, May j, Dekker D
MDPI 2020, 8,2052;doi:10.3390/microorganisms8122052; PubMed Central PMID: 33371449PMCID: PMC7767444
Spectrum of antibiotic resistant bacteria and fungi isolated from chronically infected wounds in a rural district hospital in Ghana
Krumkamp R, Oppong K, Hogan B, Strauss R, Frickmann H, Wiafe Akenten C, Boahen K, Rickerts V, McCormick Smith I, Groß U, Schulze M, Jaeger A, Loderstädt U, Sarpong N, Owusu-Dabo E, May J, Dekker D
PlosOne 2020.doi.org/10.1371/journal.pone.0237263. PubMed PMID: 32764812; PubMed Central PMCID: PMC7413558
Multicountry Distribution and Characterization of Extended-spectrum beta-lactamase-associated Gram-negative bacteria from Bloodstream Infections in Sub-Saharan Africa
Toy T, Pak GD, Duc TP, Campbell JI, El Tayeb MA, Von Kalckreuth V, Im J, Panzner U, Cruz Espinoza LM, Eibach D, Dekker DM, Park SE, Jeon HJ, Konings F, Mogeni OD, Cosmas L, Bjerregaard-Andersen M, Gasmelseed N, Hertz JT, Jaeger A, Krumkamp R, Ley B, Thriemer K, Kabore LP, Niang A, Raminosoa TM, Sampo E, Sarpong N, Soura A, Owusu-Dabo E, Teferi M, Yeshitela B, Poppert S, May J, Kim JH, Chon Y, Park JK, Aseffa A, Breiman RF, Schütt-Gerowitt H, Aaby P, Adu-Sarkodie Y, Crump JA, Rakotozandrindrainy R, Meyer CG, Sow AG, Clemens JD, Wierzba TF, Baker S, Marks F
Clin Infect Dis. 2019 Oct 30;69(Suppl 6):S449-S458.doi:10.1093/cid/ciz450. PubMed PMID: 31665776; PubMed Central PMCID: PMC6821266
Epidemiology and antimicrobial susceptibility of Salmonella enterica bloodstream isolates among febrile children in a rural district northeastern Tanzania: a cross-sectional study
Msemo OA, Mbwana J, Mahende C, Malabeja A, Gesase S, Crump JA, Dekker D, Lusingu JPA
Clin Infect Dis. 2019 Mar 7;68(Supplement2):S177-S182.doi:10.1093/cid/ciy1126. PubMed PMID: 30845323; PubMed Central: PMCID:
Fluoroquinolone-resistant Salmonella enterica, Campylobacter and Arcobacter butzleri from local and imported poultry meat in Kumasi, Ghana
Dekker D, Eibach D, Boahen KG, Akenten CW, Pfeifer Y, Zautner AE, Mertens E, Krumkamp R, Jaeger A, Flieger A, Owusu-Dabo E, May J
Foodborne Pathog Dis. 2019 May;16(5):352-358.doi10.1089/fpd.2018.2562. PubMed PMID: 30907631; PubMed Central PMCID: PMC6529854
Emergence of phylogenetically diverse and fluoroquinolone resistant Salmonella Enteritidis as a cause of invasive nontyphoidal Salmonella disease in Ghana
Aldrich C, Hartmann HFeasey N, Chattaway MA, Dekker D, Al-Emran H, Larkin L, McCormick j, Sarpong N, Le Hello S, Adu-Sarkodie Y, Panzner U, Park S E, Im J, Marks F, May J, Dallman TJ, Eibach D
PLoS Negl Trop Dis 2019 Jun 20;13(6):e0007485.doi10.1371/journal.pntd.0007485. PubMed PMID: 31220112; PubMed Central PMCID: PMC6605661
The Phylogeography and incidence of multi-drug resistant typhoid fever in sub-Saharan Africa
Park SE, Pham DT, Boinett C, Wong VK, Pak1 GD, Panzner U, Cruz Espinoza LM, von Kalckreuth V, Im J, Schütt-Gerowitt H, Crump JA, Breiman RF, Adu-Sarkodie Y, Owusu-Dabo E, Rakotozandrindrainy R, Soura AB, Aseffa A, Gasmelseed N, Keddy KH, May J, Sow AG, Aaby P, Biggs HM, Hertz JT,Montgomery JM, Cosmas L, Olack B, Fields B,Sarpong N, Razafindrabe TSJ, ´Raminosoa TM, Kabore LP, Sampo E, Teferi M, Yeshitela B, Muna Ahmed El Tayeb18, Arvinda Sooka20, Christian G. Meyer, Krumkamp R, Dekker DM et al
Nat Commun, 2018 Nov 30;9(1):5094.doi:10.1038/s41467-018-07370-z. PubMed PMID: 30504848; PubMed Central PMCID: PMC6269545
Loop-mediated isothermal amplification-based detection of typhoid fever on an automated Genie II Mk2 system – a case-control-based approach
Frickmann H, Wiemer DF, Wassill L, Hinz R, Rojak S, Wille A, Loderstädt U, Schwarz NG, von Kalckreuth V, Im J, Jeon HJ, Marks F, Owusu-Dabo E, Sarpong, May J, Eibach E, Dekker D
Acta Trop. 2018 Dec 5;190:293-295.doi10.1016/j.actatropica.2018.12.004. PubMed PMID: 30528158
Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in local and imported poultry meat in Ghana
Eibach D, Dekker D. Boahen KG, Wiafe Akenten C, Sarpong N, Belmar Campos C, Berneking L, Aepfelbacher M, Krumkamp R, Owusu-Dabo E, May J
Vet Microbiol. 2018 Ap; 217:7-12.doi:10.1016/j. vetmic.2018.02.023. PubMed PMID: 29615260
Characterization of Salmonella enterica from invasive bloodstream infections and water sources in rural Ghana
Dekker D, Krumkamp R, Eibach D, Sarpong N, Boahen KG, Frimpong M, Fechtner E, Poppert E, Hagen RM, Schwarz NG, Adu Sarkodie Y, Owusu-Dabo E, Im J, Marks F, Frickmann H, May J.
BMC Infect Dis. 2018 Jan 19;18(1):47.doi: 10.1186/s12879-018-2957-4. PubMed PMID: 29351771; PubMed Central PMCID: PMC5775569
Fever Without Source (FWS) Study Group. Malaria Coinfections in Febrile Pediatric Inpatients: A Hospital-Based Study from Ghana
Hogan B, Eibach D, Krumkamp R, Sarpong N, Dekker D, Kreuels B, Maiga-Ascofaré O, Gyau Boahen K, Wiafe Akenten C, Adu-Sarkodie Y, Owusu-Dabo E, May J
Clin Infect Dis. 2018; 66(12):1838-1845.doi10.1093/cid/cix1120. PubMed PMID: 29408951; PubMed Central PMCID: PMC5982794
Malaria co-infections in febrile paediatric inpatients: a hospital-based study from Ghana
Hogan B, Eibach D, Krumkamp R, Sarpong N, Dekker D Kreuels B, Maiga-Ascofare, Boahen KG, Wiafe Akenten C, Adu-Sarkodie, Owusu-Dabo E, May J
Clin Infect Dis. 2018 Feb 2. doi: 10.1093/cid/cix1120.2018. PubMed PMID: 29408951; PubMed Central PMCID: PMC5982794
Incidence of invasive Salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study
von Kalckreuth V, Aaby P, Adu-Sarkodie Y, El Tayeb MA, Ali M, Aseffa A, Baker S, Biggs HM, Bjerregaard-Andersen M, Breiman RF, Campbell JI, Cosmas L, Crump JA, Espinoza LM, Deerin JF, Dekker DM et al
Lancet Glob Health. 2017 Mar;5(3):e310-e323.doi: 10.1016/S2214-109X(17)30022-0. PubMed PMID: 28193398; PubMed Central PMCID: PMC5316558
Nasal carriage of Staphylococcus aureus among children in the Ashanti region of Ghana
Eibach D, Nagel M, Hogan B, Azuure C, Krumkamp R, Dekker D, Jajdiss M, Brunke M, Sarpong N, Owusu-Dabo E, May J
PLoS ONE 2017 12(1): e0170320.doi:10.1371/journal.pone.0170320. PubMed PMID: 28107412; PubMed Central PMCID: PMC5249101
Antibiotic resistance and clonal diversity of invasive Staphylococcus aureus in the rural Ashanti Region, Ghana
Dekker D, Wolters M, Mertens E, Boahen KG, Krumkamp R, Eibach E, Schwarz GN, Adu-Sarkodie Y, Rohde H, Christner M, Marks F, Sarpong N, May J
BMC Infect Dis 2016 16:7 20.doi 10,1186/s 12879-016-2048-3. PubMed PMID: 27899074; PubMed Central PMCID: PMC5129674
Extended spectrum beta-lactamases producing Enterobacteriaceae causing bloodstream infections in rural Ghana, 2007-2012
Eibach D, Campos CB, Krumkamp R, Al-Emran H, Dekker D, Boahen KG, Kreuels B, Adu-Sarkodie Y, Aepfelbacher M, P SE, Panzner U, Marks F, May J
Int J Med Microbiol. 2016 Jun;306(4):249-54.doi: 10.1016/j.ijmm.2016.05.006. PubMed PMID: 27222489
Variations of Invasive Salmonella Infections by Population Size in Asante Akim Municipal, Ghana
Cruz Espinoza LM, Nichols C, Adu-Sarkodie Y, Al-Emran HM, Baker S, Clemens JD, Dekker DM, Eibach D, Krumkamp R, Boahen K, Im J, Jaeger A, von Kalckreuth V, Pak GD, Panzner U, Park SE, Park JK, Sarpong N, Schütt-Gerowitt H, Toy T, Wierzba TF, Marks F, May J
Clin Infect Dis. 2016 Mar 15;62 Suppl 1:S17-22.doi10.1093/cid/civ787. PubMed PMID: 26933015
The Emergence of Reduced Ciprofloxacin Susceptibility in Salmonella enterica causing bloodstream Infections in Rural Ghana
Eibach D, Al-Emran HM, Dekker DM, Krumkamp R, Adu-Sarkodie Y, Cruz Espinoza LM, Ehmen C, Boahen K, Heisig P, Im J, Jaeger A, von Kalckreuth V, Pak GD, Panzner U, Park SE, Reinhardt A, Sarpong N, Schütt-Gerowitt H, Wierzba TF, Marks F, May J
Clin Infect Dis. 2016 Mar 15;62 Suppl 1:S32-6.doi10.1093/cid/civ757. PubMed PMID: 26933017
A Multicountry Molecular Analysis of Salmonella enterica Serovar Typhi With Reduced Susceptibility to Ciprofloxacin in Sub-Saharan Africa
Al-Emran HM, Eibach D, Krumkamp R, Ali M, Baker S, Biggs HM, Bjerregaard-Andersen M, Breiman RF, Clemens JD, Crump JA, Cruz Espinoza LM, Deerin J, Dekker DM et al
Clin Infect Dis. 2016 Mar 15;62 Suppl 1:S42-6.doi:10.1093/cid/cif788 PubMed PMID: 26933020; PubMed Central PMCID: PMC4772832
Detection of a Novel gyrB Mutation Associated With Fluoroquinolone-Nonsusceptible Salmonella enterica serovar Typhimurium Isolated From a Bloodstream Infection in Ghana
Al-Emran HM, Heisig A, Dekker D, Adu-Sarkodie YA, Cruz Espinoza LM, Panzner U, von Kalckreuth V, Marks F, Park SE, Sarpong N, May J, Heisig P
Clin Infect Dis. 2016 Mar 15;62 Suppl 1:S47-9.doi:10.1093/cid/civ790 PubMed PMID: 26933021
Validation and Identification of Invasive Salmonella Serotypes in Sub-Saharan Africa by Multiplex Polymerase Chain Reaction
Al-Emran HM, Krumkamp R, Dekker DM et al
Clin Infect Dis. 2016 Mar 15;62 Suppl 1:S80-2.doi:10.1093/cid/Civ782. PubMed PMID: 26933026
16S rRNA Gene Sequence-Based Idetification of Bacteria in Automatically Incubated Blood Culture Materials from Tropical Sub-Saharan Africa
Frickmann H*, Dekker D*, Schwarz GN, Hahn A, Boahen K, Sarpong N, Adu-Sarkodie Y, Halbgewachs E, Marks F, von Kalckreuth V, Poppert S, Loderstaedt U, May J, Hagen RM
PLoS ONE. 2015 Aug 13;10(8):e0135923.doi:10.1371/joirnal.pone.0135923 PubMed PMID: 26270631; PubMed Central PMCID: PMC4535881 [*contributed equally]
Drinking water from dug wells in rural Ghana-Salmonella contamination, environmental factors and genotypes
Dekker DM, Krumkamp R, SarpongN, Frickmann H, Boahen Kg, Frimpong M, Asare R, Larbi R, Hagen RM, Poppert S, Rabsch W, Marks F, Adu-Sarkodie Y, May J
Int J Environ Res Public Health. 2015 Mar 27;12(4):3535-46.doi:10.3390/ijerph120403535. PubMed PMID: 25826395; PubMed Central PMCID: PMC4410201