Enteric Diseases Reference Unit (EDRU)

Overview

The Enteric Diseases Reference Unit at the NICD was started in 1997, under the guidance of a pathologist and a part-time technologist. At that stage, the unit was still part of the old South African Institute for Medical Research and there was very little capacity in the SAIMR to identify enteric bacterial pathogens. Over the next few years, the capacity was increased through the hiring of extra staff members to its current complement, the unit developed full capacity to serotype Salmonella enterica (previously only a partial service was offered) and Shigella species and has had training in the serotyping of diarrhoeagenic Escherichia coli, from the WHO Reference Centre (Statens Serum Institut, Denmark). EDRU took over Vibrio cholerae work from the old Public Health Laboratory and has developed capacity in both phenotyping and genotyping of this group of organisms. Future work includes improving capacity to identify and characterise other enteric bacteria, including Campylobacter, develop other techniques such as cell culture, evaluate new tests for enteric pathogens and participate further in projects involving vaccine development for these pathogens.

EDRU collects data on patients presenting throughout South Africa with both invasive and non-invasive disease caused by Salmonella species (including Salmonella Typhi), Shigella species, Vibrio cholerae and diarrhoeagenic Escherichia coli. In order to make these data representative and reflective of disease burden in each province in the country, we actively motivate all diagnostic laboratories throughout the country to voluntarily submit limited demographic details and isolates to us centrally. In exchange, we offer serogrouping and serotyping results free of charge (urgent results need to be requested telephonically), regular feedback (quarterly reports by province sent to every laboratory participating) and aggregated numbers are published in the NICD Bulletin. We actively contact laboratories to assess numbers of missed cases.

In addition to serogrouping and serotyping, E-tests are used to determine the minimum inhibitory concentration (MIC) of each isolate to antimicrobial agents, according to CLSI guidelines. We also perform genotypic characterization of isolates, should this be required, such as in outbreak situations. The molecular epidemiology of these bacterial pathogens is continually being elucidated, specifically that of outbreak or epidemic-prone pathogens such as Salmonella Typhi, Shigella dysenteriae type 1 and Vibrio cholerae. A multiplex polymerase chain reaction is used to elucidate the presence of toxin genes in diarrhoeagenic E. coli. Our unit is developing its molecular research laboratory involved with characterising the molecular basis for antimicrobial resistance in these pathogens and has plans to further characterize the mechanism of disease due to these pathogens at a molecular and cellular level.

Together with collaborators from the CDC in the USA, a number of sites in the country are performing "enhanced" surveillance, where additional clinical data on all patients is being collected, by trained surveillance officers (registered nursing sisters), representing almost all the provinces. The project comprises a vibrant and energetic team of pathologists, clinicians, scientists, technologists, clerks and surveillance officers.

The unit also comprises an enthusiastic team of senior pathologists and scientists who are actively involved in post-graduate training. The staff has a specialized programme for the training of microbiology registrars, and over a two-week period, registrars are exposed to a range of biochemical, serotyping and molecular techniques in the identification of bacterial enteric pathogens. The senior staff members are experienced in post graduate supervision of scientists and have recently started projects with epidemiology students who are examining the extensive database.

Contact Us

Staff

Annual Reports

Notice Boards

Publications

Links

EDRU staff

Back row (left to right): Nomsa Tau, Molebogeng Malotle, Mzikazi Dickmolo, Vashnee Moonalall, Tshilidzi Mazibuko, Karen Keddy, Emily Dloboyi, Mimmy Ngomane, Anthony Smith, Florah Mnyameni, Husna Ismail, Portia Mogale.
Front row (left to right): Arvinda Sooka, Mpilo Mtambo, Zwiitavhathu Makhari, Krpasha Govindasamy, Donald van der Westhuizen.

Contact us

Please direct any queries via one of the following:

Tel: +27 (11) 3866269
Fax: +27 (11) 5550433
e-mail:

Postal address:

Private Bag X4,
Sandringham,
2131,
Gauteng,
South Africa.

Physical address:

SAVP Building (North Block Upper),
1 Modderfontein Road,
Sandringham,
Gauteng,
2192.

Staff

Head of Department

Dr Karen Keddy; MBBCh, BSc (Med), FCPath (SA), MMed, DTM&H
Senior pathologist
Tel: +27 (11) 3866269
Fax: +27 (11) 5550433
e-mail:

Medical Scientists

Dr Anthony Smith, BSc (Hons) PhD
Senior medical scientist
Tel: +27 (11) 5550348
Fax: +27 (11) 5550430
e-mail:

Ms Arvinda Sooka, ND MT MSc
Medical scientist and Laboratory controller
Tel: +27 (11) 3866235
Fax: +27 (11) 5550433
e-mail:

Ms Husna Ismail, BSc (Hons)
Medical scientist
Tel: +27-11-5550426
Fax: +27-11-5550433
E-mail:

Ms Nomsa Tau, BSc (Hons)
Medical scientist
Tel: +27-11-5550426
Fax: +27-11-5550433
E-mail:

Mr Donald van der Westhuizen, BSc (Hons)
Intern scientist
Tel: +27-11-5550426
Fax: +27-11-5550433
E-mail:

Medical Technologists

Ms Florah Mnyameni, ND MT
Medical technologist
Tel: +27 (11) 5550341
Fax: +27 (11) 5550430
e-mail:

Ms Mimmy Ngomane, ND MT
Medical technologist
Tel: +27 (11) 5550341
Fax: +27 (11) 5550430
e-mail:

Ms Tshilidzi Mazibuko, ND MT
Medical technologist
Tel: +27-11-5550333
Fax: +27-11-5550433
E-mail:

Ms Rosah Kganakga, ND MT
Medical technologist
Tel: +27-11-5550333
Fax: +27-11-5550433
E-mail:

Laboratory Technicians

Ms Vashnee Moonalall, BSc
Laboratory technician
Tel: +27 (11) 5550341
Fax: +27 (11) 5550430
e-mail:

Mr Mpilo Mtambo
Laboratory technician
Tel: +27 (11) 5550341
Fax: +27 (11) 5550430
e-mail:

Students

Ms Zwiitavhathu Makhari, BSc (Hons)
MSc student
Tel: +27-11-5550426
Fax: +27-11-5550433
E-mail:

Administrative Support Staff

Ms Mzikazi Dickmolo
Secretary
Tel: +27-11-3866477
Fax: +27-11-5550433
E-mail:

Ms Portia Mogale
Data input clerk
Tel: +27 (11) 5550343
Fax: +27 (11) 5550430
e-mail:

Ms Emily Dloboyi
Laboratory clerk
Tel: +27-11-5550343
Fax: +27-11-5550433
E-mail:

Annual Reports

Click here to view the 2008 Annual Report for the NICD.

Notice Boards

Events

The first planning meeting to discuss the establishment of PulseNet sub-Saharan Africa is scheduled for 11-12 August 2010 and the venue will be the National Institute for Communicable Diseases, Johannesburg, South Africa. All surveillance laboratories in sub-Saharan Africa who work with enteric pathogens and would be interested to become involved with PulseNet and perhaps attend the first planning meeting, are requested to make contact with the meeting organizer, Dr Anthony Smith at: .

Job opportunities

MSc/PhD opportunities
We have positions available for students with or completing their BSc (Hon) who wish to complete an MSc or MSc students wishing to do a PhD.

Courses/Seminars

No information at present

Publications

Recent (last 5 years) publications by members of staff

Smith AM, Govender N, Keddy KH, for the Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA). 2010. Quinolone-resistant Salmonella Typhi in South Africa, 2003-2007. Epidemiology and Infection 138:86-90.

Keddy KH, Dwarika S, Crowther P, Perovic O, Wadula J, Hoosen A, Sooka A, Crewe-Brown HH, Smith AM, for the Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA). 2009. Genotypic and demographic characterization of invasive isolates of Salmonella Typhimurium in HIV co-infected patients in South Africa. Journal of Infection in Developing Countries 3:585-592 .

Govender N, Smith AM, Karstaedt A, Keddy KH, for the Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA). 2009. Plasmid-mediated quinolone resistance in Salmonella from South Africa. Journal of Medical Microbiology 58:1393-1394 .

Smith AM, K eddy KH, Sooka A, Ismail H, De Jong GM, Hoyland G, for the Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA). 2009. Analysis of a temporal cluster of Shigella boydii isolates in Mpumalanga, South Africa, November to December 2007. Journal of Infection in Developing Countries 3:65-70 .

McGee L , Biek D, Ge Y, Klugman M, du Plessis M, Smith AM, Beall B, Whitney CG, Klugman KP. 2009. In vitro evaluation of the antimicrobial activity of ceftaroline against cephalosporin-resistant isolates of Streptococcus pneumoniae . Antimicrobial Agents and Chemotherapy 53:552-556.

Smith AM, Sooka A, Ismail H, Nadan S, Crisp N, Weenink E, Keddy KH, for the Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA). 2009. Analysis of Vibrio cholerae isolates from the Northern Cape province of South Africa. Journal of Medical Microbiology 58:151-154. Smith AM, Keddy KH, de Wee L. 2008. Characterization of cholera outbreak isolates from Namibia, December 2006 to February 2007. Epidemiology and Infection 136:1207-1209.

Von Gottberg A, Klugman KP, Cohen C, Wolter N, de Gouveia L, du Plessis M, Mpembe R, Quan V, Whitelaw A, Hoffman R, Govender N, Meiring S, Smith AM, Schrag S, for the Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA). 2008. Emergence of levofloxacin-non-susceptible Streptococcus pneumoniae and treatment for multidrug-resistant tuberculosis in children in South Africa: a cohort observational surveillance study. The Lancet 371:1108-1113.

Wolter N, Smith AM, Farrell DJ, Blackman Northwood J, Douthwaite S, Klugman KP. 2008. Telithromycin resistance in Streptococcus pneumoniae is conferred by a deletion in the leader sequence of erm(B) that increases rRNA methylation. Antimicrobial Agents and Chemotherapy 52:435-440.

Keddy KH, Nadan S, Govind C, Sturm AW, for the Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA). 2007 . Evidence for a clonally different origin of the two cholera epidemics of 2001-2002 and 1980-1987 in South Africa. Journal of Medical Microbiology 56:1644-1650.

Smith AM, Gouws A-M, Hoyland G, Sooka A, Keddy KH, for the Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA). 2007. Outbreaks of food-borne disease - a common occurrence but rarely reported. South African Medical Journal 97:1272.

Wolter N, Smith AM, Low DE, Klugman KP. 2007. High-level telithromycin resistance in a clinical isolate of Streptococcus pneumoniae. Antimicrobial Agents and Chemotherapy 51:1092-1095.

Anderson R, Steel HC, Cockeran R, Smith AM, von Gottberg A, De Gouveia L, Brink A, Klugman KP, Mitchell TJ, Feldman C. 2007. Clarithromycin alone and in combination with ceftriaxone inhibits the production of pneumolysin by both macrolide-susceptible and macrolide-resistant strains of Streptococcus pneumoniae. Journal of Antimicrobial Chemotherapy 59:224-229.

Coulson GB, Von Gottberg A, Du Plessis M, Smith AM , De Gouveia L, Klugman KP, for the Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA). 2007. Epidemiology of meningococcal disease in South Africa 1999-2002. Emerging Infectious Diseases 13:273-281.

Wolter N, Smith AM, Farrell DJ, Klugman KP. 2006. Heterogeneous macrolide resistance and gene conversion in the pneumococcus. Antimicrobial Agents and Chemotherapy 50:359-361. Smith AM , Klugman KP. 2005. Amino acid mutations essential to production of an altered PBP 2X conferring high-level β-lactam resistance in a clinical isolate of Streptococcus pneumoniae. Antimicrobial Agents and Chemotherapy 49:4622-4627.

Wolter N, Smith AM, Farrell DJ, Schaffner W, Moore M, Whitney CG, Jorgensen JH, Klugman KP. 2005 . Novel mechanism of resistance to oxazolidinones, macrolides, and chloramphenicol in ribosomal protein L4 of the pneumococcus. Antimicrobial Agents and Chemotherapy 49:3554-3557.

Smith AM , Feldman C, Massidda O, McCarthy K, Ndiweni D, Klugman KP. 2005. Altered PBP 2A and its role in the development of penicillin, cefotaxime, and ceftriaxone resistance in a clinical isolate of Streptococcus pneumoniae. Antimicrobial Agents and Chemotherapy 49:2002-2007.

Links

National Health Laboratory Service

University of the Witwatersrand

National Research Foundation

Medical Research Council

PulseNet International

WHO Global Foodborne Infections Network