Months after guests fell sick during a conference at Weston hotel in Nairobi, a health expert came to a shocking conclusion: The outbreak thought to have been caused by cholera was the result of a different bacteria.
Gunturu Revathi, the head of microbiology at the Aga Khan Hospital’s department of pathology found that there is a germ, different in structure, but causing diseases in the same way the cholera bacteria does.
The bacteria, Aeromonas Hydrophila, are causing havoc in Nairobi with deaths from diarrhoea being reported. Initially, some of these cases had been linked to cholera. Prof Revathi also found that the bacteria had started showing drug-resistant capabilities.
She also said her colleagues from Gertrude hospital had also isolated the bacterium from samples of patients presenting with cholera-like symptoms. “Aeromonas also has symptoms similar to cholera such as rice looking diarrhoea,” she said, adding that sometimes it was difficult to identify the pathogens during a public health crisis due to the lack of proper testing systems.
A bout of diarrhoea caused by the microorganism is also managed the same way cholera is. In severe cases, antibiotics such as tetracycline can be administered to the patient to reduce the shedding of the pathogen to the environment when the patient diarrhoeas. Whether Aeromonas or cholera, diarrhoea is unforgiving in children and the elderly. Collectively, Aeromonas causes many diseases in people and animals. It has been isolated in water — be it fresh or bottled, polluted water, sludge or garbage.
The bacteria are also found in meat and meat products. From 1960, it is yet to be clearly established the diseases Aeromonas Hydrophila causes, but literature points to acute and chronic diarrhoea with blood or looking like rice water accompanied by vomiting. Prof Revathi said identification is also made harder by the fact that Aeromonas Hydrophila also looks like the cholera bacterium under a microscope. The microbiologist said it was possible the bacteria may be responsible for the diarrheal diseases, including cholera, but due to a weak laboratory system, it was never discovered. To tell them apart, a biochemical identification is necessary, where the microorganism is studied not only for how it looks, but also the chemicals that it possesses and how a combination makes it behave when it is in the body of an animal or a person. Experts from labs that participated in the diagnosis of the outbreak at Weston — Kenya Medical Research Institute (Kemri) and the national public laboratory — said they did not run tests to rule out Aeromonas.
A scientist from Kemri explained that even if it was isolated, it does not mean it was the one responsible for the disease at that moment. “There is a still a lot of contestation about Aeromonas, and even the few studies that have been conducted about it in Kenya are basic and need further studies,” said the expert. Over the years, cholera has become endemic in Nairobi even in areas which never used to experience outbreaks. The Health ministry and institutions such as Kemri have studied the cholera bacteria Vibrio Cholerae. This has allowed scientists to know how the pathogen acts, and changes, critical information that guides the scientific community to know which drugs should be used during an outbreak. There is little of that kind of study for Aeromonas due to various reasons. The main reason is there are very few labs in the country with the capability to conduct, among many other studies, sequencing, the determination of what molecules a microorganism is made up of.
There are labs belonging to private entities such as International Livestock Research Institute Gertrude’s, Aga Khan’s and Kemri labs in Nairobi, Busia, Kericho, Mombasa and Kisumu. Prof Revathi said even the public labs have come to existence due to the threat of antimicrobial resistance, where drugs are losing their ability to treat diseases. She told HealthyNation: “Antimicrobial resistance is now the gravy wagon, all the donor funding goes there, but I wish the government would know that a good system and quality does not come overnight”. Even with good labs, the number of microbiologists competent enough to run these tests are too few and, according to Prof Revathi, the training and supervision is below par.