The gut microbiota has emerged as a key human health and disease determinant. However, there is a significant knowledge gap regarding the composition, diversity, and function of the gut microbiota, specifically in the African population. This scoping review aims to examine the existing literature on gut microbiota research conducted in Africa, providing an overview of the current knowledge and identifying research gaps. A comprehensive search strategy was employed to identify relevant studies. Databases including MEDLINE (PubMed), African Index Medicus (AIM), CINAHL (EBSCOhost), Science Citation index (Web of Science), Embase (Ovid), Scopus (Elsevier), WHO International Clinical Trials Registry Platform (ICTRP), and Google Scholar were searched for relevant articles. Studies investigating the gut microbiota in African populations of all age groups were included. The initial screening included a total of 2136 articles, of which 154 were included in this scoping review. The current scoping review revealed a limited number of studies investigating diseases of public health significance in relation to the gut microbiota. Among these studies, HIV (14.3%), colorectal cancer (5.2%), and diabetes mellitus (3.9%) received the most attention. The top five countries that contributed to gut microbiota research were South Africa (16.2%), Malawi (10.4%), Egypt (9.7%), Kenya (7.1%), and Nigeria (6.5%). The high number (n = 66) of studies that did not study any specific disease in relation to the gut microbiota remains a gap that needs to be filled. This scoping review brings attention to the prevalent utilization of observational study types (38.3%) in the studies analysed and emphasizes the importance of conducting more experimental studies. Furthermore, the findings reflect the need for more disease-focused, comprehensive, and population-specific gut microbiota studies across diverse African regions and ethnic groups to better understand the factors shaping gut microbiota composition and its implications for health and disease. Such knowledge has the potential to inform targeted interventions and personalized approaches for improving health outcomes in African populations.

The prevalence of pathogens on potatoes (Solanum tuberosum) grown in soil amended with a pathogen rich wastewater sludge was investigated. Bacteria of the family Enterobacteriaceae are important pathogens causing intestinal and systemic illness of humans and other animals. Type B sludge was used. Sludges investigated are the high metal and the low metal sludges. Microorganisms in the sludge-amended soil were using culture-based technique. Salmonella and E. coli were observed in tested soil samples. No microorganisms were isolated from control samples taken throughout the process of the experiment. At harvest time, some of the potato samples from LMS soil were contaminated. These potatoes were subjected to further investigation using molecular techniques (polymerase chain reaction) with fD1 and rP2 as primers. Organisms identified from the sequenced potato peel samples with the BLAST search tool included Enterobacter agglomerans (Pantoea agglomerans), several Buttiauxella spp., Pectobacterium spp., Erwinia spp. and a few Pantoea spp. Other than the E. agglomerans, which is commonly found in the gut and upper respiratory tract of humans and in the environment, all the other species identified were found to be mainly either plant or soil pathogens. The E. agglomerans are not primary pathogens but secondary opportunistic pathogens particularly in immuno-compromised individuals. These results suggest that growing high risk crops using wastewater sludge contaminated soil may lead to limited infestation of produce with primary pathogens. It appears that the use of HMS due to early pathogen die-off provides less risk of infection than the LMS. However, proper treatment of wastewater sludge to reduce pathogen load is essential prior to its use as soil conditioner.

Introduction: Liddle syndrome is an autosomal dominantly inherited disorder usually arising from single mutations of the genes that encode for the alpha, beta and gamma epithelial sodium channel (ENaC) subunits. This leads to refractory hypertension, hypokalaemia, metabolic alkalosis, hyporeninaemia and hypoaldosteronism, through over-activation of the ENaC.Case presentation: We describe a 5-day old neonate who presented with severe hypernatraemic dehydration requiring admission to Steve Biko Academic Hospital in South Africa in 2012. Further evaluation revealed features in keeping with Liddle syndrome. Two compound heterozygous mutations located at different subunits encoding the ENaC were detected following genetic sequencing done in 2020. The severe clinical phenotype observed here could be attributed to the synergistic effect of these known pathological mutations, but may also indicate that one of the other variants detected has hitherto undocumented pathological effects.Management and outcome: This child’s treatment course was complicated by poor adherence to therapy, requiring numerous admissions over the years. Adequate blood pressure control was achieved only after the addition of amiloride at the end of 2018, which raised the suspicion of an ENaC abnormality.Conclusion: To our knowledge, this is the first Liddle syndrome case where a combined effect from mutations resulted in severe disease. This highlights the importance of early recognition and management of this highly treatable genetic disease to prevent the grave sequelae associated with long-standing hypertension. Whole exome sequencing may assist in the detection of known mutations, but may also unveil new potentially pathological variants.What this study adds: This study highlights the importance of developing a high index of suspicion of tubulopathy such as Liddle syndrome for any child presenting with persistent hypertension associated with hypokalaemic metabolic alkalosis.

Introduction: Maternally inherited diabetes and deafness (MIDD) is caused by the m.3243A>G pathogenic variant in maternally inherited mitochondrial DNA. Diabetes is prevalent in our setting; however, MIDD is rarely diagnosed. This study, undertaken in Pretoria, South Africa, highlights the variable presentation of MIDD in different patients within the same family. Case presentation: A 45-year-old man (proband) with hearing impairment was referred to the endocrine unit in July 2015 due to poor glycaemic control (HbA1c = 13%). His clinical and biochemical features were in keeping with MIDD. A genetic study of accessible maternal relatives was pursued. His mother had difficulty hearing and reportedly died from an unspecified cardiovascular cause. Two sisters with diabetes and deafness died of cardiac-related conditions. One nephew had diabetes (HbA1c = 7.7%), hearing loss and tested positive for m.3243A>G. A third sister tested positive for m3243A>G, but aside from bilateral mild hearing loss in higher frequencies, showed no other signs of target organ damage. Her daughter developed end-stage kidney failure necessitating a transplant, while her son had no biochemical abnormalities and was negative for m.3243A>G. Management and outcome: A multidisciplinary team managed and screened for complications of the patient and his maternal relatives. Proband died prior to genetic testing. Conclusion: Most MIDD patients initially present with symptoms of diabetes only, and it is probable that many cases remain undiagnosed. A high index of suspicion is necessary when encountering a family history of both diabetes and impaired hearing, and screening should be offered to the patient’s maternal relatives. What the study adds: This study demonstrates the importance of proper assessment when evaluating a patient with diabetes and a family history of hearing loss.

Background: Glycated haemoglobin (HbA1c) is a useful biomarker for the monitoring and diagnosis of diabetes mellitus. In the northern hemisphere, there is evidence of seasonal fluctuations in HbA1c with values being higher in cooler months and lower in warmer months. In the southern hemisphere, there is one description from Australia. It is not known if this would also pertain in other temperate climates. We explored the relationship between seasons, HbA1c and estimated average glucose in South Africa. Methods: This was a retrospective analysis. HbA1c data were obtained from January 2016 to December 2020 from two different provinces with different climates. The mean HbA1c values and mean monthly temperatures were compared for each year. Results: We show seasonal variation for HbA1c and estimated average glucose (eAG) in both provinces (p < 0.01). The population was further subdivided and evaluated based on gender and age. Glycated haemoglobin was higher in cooler months and lower in the warmer months for all the data and for both the categories (age and gender; p < 0.01). Conclusion: South Africa shows demonstrable seasonal variation in glycated haemoglobin that needs to taken into account when managing diabetes mellitus. Contribution: Awareness of this seasonal effect may assist in more efficient use of HbA1c to monitor and diagnose diabetes mellitus and will assist in modifying therapeutic targets for achieving good glycaemic control.

The African Journal of Laboratory Medicine focuses on the role of the laboratory and its professionals in the clinical and public healthcare sectors, and is specifically based on an African frame of reference.