Pyrosequencing for rapid detection of tuberculosis resistance to Rifampicin and Isoniazid in Syrian and Lebanese clinical isolates

Rapid and accurate techniques are always welcomed for the detection of resistant strains of Mycobacterium tuberculosis MTB. The objective of this study is to evaluate the pyrosequencing technology for the detection of MTB resistance to Rifampicin [RIF] and Isoniazid [INH] in Syrian and Lebanese clinical strains; 66 strains resistant to INH, among them 56 resistant also to RIF, were tested. Four pyrosequencing assays were optimized and applied to the following loci: rpoBrpoB RIF resistance-determining region, katG, the promoter regions of inhA and ahpC-oxyR intergenic region. The prevalence of mutations on codon 315 of the katG gene, inhA and ahpc-oxyR were 42.4%, 21.2% and 9.0%, respectively, which make an overall sensitivity of 72.6% for INH resistance. All RIF-resistant strains contained at least one non-synonymous codon change in the sequenced rpoB region [507-533] relative to the ATCC reference strain. The RIF drug resistance region [RRDR] sequencing identified 96 modified codons representing 34 different mutations. The high sensitivity and the short turnaround time combined with multilocus sequencing of several isolates in parallel make pyrosequencing an attractive method for drug resistance screening for MTB

[Anti-tetanus immunity among university students and health staff in North Lebanon and administration of anti-tetanus serums in two hospitals]

Tetanus is a serious illness that kills about one million people a year globally. This study aimed to i] evaluate immunity against tetanus [by antibodies titres in blood] among health staff and students at the Public Health Faculty, Lebanese University, ii] explore the determinants of the anti-tetanus immunity by a questionnaire and iii] estimate anti-tetanic serum use in the emergency departments of two hospitals [1 private, 1 public] in Tripoli. Most of the participants [76.6%] had anti-tetanus antibody titres >/= 0.1 UI/mL. There was no association between immune status and gender [P = 0.614] but more participants =/< 25 years were immunized than those > 25 years [P < 0.001] and more students were immunized than employees [P = 0.032]. There was an inverse association between anti-tetanus immunity and having visited a physician in the past year [P = 0.009]. In 2011, 1037 people received anti-tetanus immunoglobulins at the hospitals, 73% at the private hospital. Vaccination campaigns targetting adults > 25 years may be warranted to assure good anti-tetanus protection and avoid administration of anti-tetanus immunoglobulins in emergency departments

Mycobacterium tuberculosis spoligotypes circulating in the Lebanese population: a retrospective study

Genotyping Mycobacterium tuberculosis in Lebanon on the national level may be beneficial for assessing patients and monitoring the therapeutic response to DOTS. This study aimed to characterize the spoligotypes of clinical isolates of M tuberculosis patients collected between April 2004 and October 2005 from all Lebanese provinces. Isolates [n = 60] were cultured and identified by their biochemical characteristics. DNA extracts of these samples were amplified by PCR and genotyped by spoligotyping. Thirteen [13] patterns of M tuberculosis complex family strains were identified: 41.6% of the strains belonged to the T 1 family, 25.0% to LAM 9,10.0% to Haarlem 3, 3.3% to each of CAS, LAM 8, BCG and Family 36 and17% to each of Haarlem 1, LAM 10, S, M. africanum, X 1 and T 3 families. The noticeable absence of Beijing and East African Indian families was not,consistent with the patterns reported in neighbouring countries. A more inclusive study of the Lebanese population Is necessary to accurately identify most of the prevailing families in the country

Preliminary study on the prevalence of Campylobacter in childhood diarrhoea in north Lebanon

Campylobacter species are a major cause of human diarrhoeal disease worldwide. In Lebanon, the true prevalence of Campylobacter infections and the species distribution in childhood diarrhoea are not known. This study in 2010 investigated the prevalence of Campylobacter species and its possible etiologic role in childhood diarrhoea in north Lebanon. A total of 90 stool samples from children [aged 1 month to 10 years] presenting with diarrhoea were collected from 5 hospitals. A polymerase chain reaction technique [PCR] was used for each sample for the amplification of all Campylobacter species followed by 5 PCR reactions for the amplification of C. jejuni, C. hyointestinalis, C. coli, C. fetusand C. upsaliensis. Of the 90 samples, 10 were positive for Campylobacter species [11.1%]: 1 for C .coli, 1 for C. jejuni, 2 for both C. jejuni and C. coli, and 6 could not be identified to the species level with the available primers. Campylobacter species is frequently associated with childhood diarrhoea in north Lebanon but Campylobacter infection may be significantly underdiagnosed because the search for Campylobacteria not part of the routine stool culture

[Infections with respiratory syncytial virus in North Lebanon-prevalence during winter 2008]

Between 1 December 2007 and 31 May 2008, we analysed 120 nasopharyngeal swabs for the presence respiratory syncytial virus [RSV] infection in 120 children aged 15 days to 6 years, hospitalized in 2 hospitals in North Lebanon. Of the 120 samples, 32 were positive [26.7%] for RSV. There was a peak in January which progressively disappeared from February to May. Being positive for RSV was significantly associated with the presence of rhinorrhoea and dyspnoea as clinical symptoms and the absence of pneumonia signs on chest X-ray and the diagnosis of bronchitises or bronchiolitis. Testing for RSV is important in cases of respiratory infections in children as it may limit unnecessary prescription of antibiotics

Characterization of Mycobacterium tuberculosis of Lebanese patients by double-repetitive-element polymerase chain reaction

Molecular studies have been successfully applied in evaluating epidemiological linkages in tuberculosis. A total of 87 isolates of Mycobacterium tuberculosis were collected from patients in all regions of Lebanon and characterized in terms of drug sensitivity. Double-repetitive-element polymerase chain reaction was used to differentiate between strains. Various correlations related to age, sex, region, sensitivity and genotype were examined. Several genotypes were more common in certain age ranges. Male patients appeared more likely either to be infected by or to develop multi-drug resistant strains. There was also evidence for a distribution of genotype groups indicating some level of geographical isolation and hence separate evolution of M. tuberculosis strains

Characterization of Mycobacterium tuberculosis in Syrian patients by double-repetitive-element polymerase chain reaction

The role of previous treatment in the dynamics of tuberculosis transmission has not been adequately investigated. Mycobacterium tuberculosis isolates from previously treated patients [n = 88] from all regions of Syrian Arab Republic were characterized in terms of antibiotic sensitivity and genotyping using double-repetitive-element polymerase chain reaction [DRE-PCR] method for the proximity of the repetitive DNA elements IS6110 [a mobile genetic element] and PGRS. The 88 isolates resulted in 59 different DRE-PCR patterns. Correlations related to age, sex, region, sensitivity and genotype were examined. All regions of the country showed high levels of genotype diversity, suggesting a low level of transmission of M. tuberculosis strains in previously treated patients

[Typhoid fever in north Lebanon: a 8-year study [1992-1999] using the Widal test]

We evaluated the frequency of typhoid fever in north Lebanon over an 8-year period [1992-1999] in patients admitted with fever to the Islami de Bienfaisance Hospital in Tripoli. We analysed 7391 serum samples for Salmonella typhi infection using the Widal and Felix tests. The cut-off value for infection was an agglutinin O titre >/= 1/160 [a value validated in an earlier study in the same region]. Of the 7391 samples, 1131 [15.3%] had an agglutinin O titre >/= 1/160. The 8-year surveillance showed there was a progressive decrease in the frequency of the disease. However with over 100 cases annually, typhoid is endemic in the area and could cause major outbreaks. The monthly analysis shows that we have an increase in summer, whilst a decrease is observed in winter

[Prevalence of infection by intestinal parasites in north Lebanon: 1997-2001]

We determined the prevalence of intestinal parasites in the north of Lebanon between 1997 and 2001. We analysed the parasitology records of 17126 patients and evidence of parasitic infections was found in 5 713 [33.35%] cases. There was no significant difference in prevalence for males or females for any of the parasites. The most prevalent parasites were Entamoeba coli [38.45%], Ascaris lumbricoides [37.14%], Giardia lamblia [15.39%], Ent. histolytica [4.57%] and Taenia sp. [3.3%]. A comparison between our data and results of previous studies in Lebanon in 1937, 1939, 1956, 1967 and 1993 showed an increase in the prevalence of A. lumbricoides and G. lamblia in the period 1997-2001, with less marked changes in the prevalence of the other parasites