Molecular study of astrovirus, adenovirus and norovirus in community acquired diarrhea in children: One Egyptian center study

Objective To determine the prevalence of astrovirus, norovirus, adenovirus in children below five years old with diarrhea by multiplex reverse transcriptase polymerase chain reaction (RT-PCR) along with rotavirus antigen detection by enzyme linked immunosorbant assay. Methods The study was conducted on children below five years old complaining of acute diarrhea. The study included stool examination by molecular method for detection of norovirus, adenovirus and astrovirus by multiplex RT-PCR. Rotavirus antigen was detected in the stool by enzyme linked immunosorbant assay. Results The study included 100 children below 5 years old with acute diarrhea. Multiplex RT-PCR was positive in 34% of the children. The most frequently detected virus was rotavirus (44%), followed by norovirus (30%), adenovirus (20%) and astrovirus (14%). The clinical symptoms were more significantly associated with viral diarrhea such as fever (P = 0.03), bloody diarrhea (P = 0.025), vomiting (P = 0.000 1) and watery diarrheas (P = 0.05). The frequency of diarrhea with viral pathogen was significantly presented in winter season (39.7%). There were significant frequencies of norovirus and adenovirus in age ranging 1–2 years old (P = 0.04, P = 0.01 respectively). Conclusions The present study spotlights on the prevalence of viral pathogens as an important etiology in diarrhea in children below five years old. Astrovirus, norovirus and adenovirus are common along with rotavirus in this group of patients. Multiplex PCR leads to improve the laboratory diagnosis of these viruses along with antigen detection method. Further longitudinal studies are required to evaluate the epidemiological data associated with these viruses and for proper management of such drastic infection.

Value of procalcitonin as a biomarker for postoperative hospital-acquired pneumonia after abdominal surgery / 대한마취과학회지

BACKGROUND: Hospital-acquired pneumonia (HAP) is a common complication after abdominal surgery. The aim of this study was to evaluate the role of procalcitonin (PCT) and C-reactive protein (CRP) as early biomarkers for the diagnosis of postoperative HAP after abdominal surgery. METHODS: This study was conducted on 100 patients undergoing abdominal surgery. White blood cell counts, highest body temperature, and serum levels of CRP and PCT were recorded preoperatively and daily postoperatively until postoperative day (POD) 5. Chest radiography was performed preoperatively and daily postoperatively until POD 5. RESULTS: HAP was diagnosed in 14% of patients. Regarding the biomarkers studied after POD 1, CRP and PCT were significantly higher in patients with HAP than in those without HAP (P < 0.05). On POD 2, PCT had higher sensitivity and specificity (84% and 72%, respectively) than those for CPR (70% and 60%, respectively). The cut-off value of PCT on POD 2 was 1.4 ng/ml. On POD 3, 4, and 5, the sensitivity and specificity of PCT and CRP were not significantly different. CONCLUSIONS: PCT and CRP are accurate biomarkers for early prediction of postoperative HAP after abdominal surgery. The diagnostic ability of PCT was significantly better than that of CRP on POD 2. After POD 2, the diagnostic ability was not significantly different between the biomarkers.

high prevalence of listeria monocytogenes peritonitis in cirrhotic patients of an Egyptian medical center

Spontaneous bacterial peritonitis [SBP] is a potentially lethal complication of cirrhosis. It is probably the most characteristic infectious complication of cirrhosis. The aim of this study was to evaluate the bacterial and fungal causes of SBP in Egyptian population. Furthermore to predict the occurrence of rare pathogen like Listeria monocytogenes in those patients. The study included 100 patients with end stage liver disease associated with ascites. Patients were suspected to have SBP. The ascitic fluids were subjected to full cytological and microbiological study. The peritoneal fluid cytological study revealed that 50 samples had cell counts >250 cells/mm[3]. 37 samples had growth and 13 samples had no growth [CNNA]. The distribution of isolated pathogens was Gram positive cocci 48.8% followed by L. monocytogenes 24.4%, Gram negative bacilli 12.2% and Mycobacterium tuberculosis 7.3. The cells counts associated with listeria culture were 475 cells/mm[3] with sensitivity 70% and specificity 68%.The study highlights the prevalence of microorganisms in Egyptian patients with liver cirrhosis associated with ascites. It reflects the occurrence of L. monocytogenes as an important pathogen of such clinical situation. Other rare pathogens likeM. tuberculosis are not uncommon in those patients

Role of urinary interleukin-8 in children with febrile urinary tract infection

lnterleukin-8 [IL-8] is produced within the urinary tract during urosepsis and is involved in the recruitment of neutrophils to the urinary compartment, in addition, deliberate colonization of the human urinary tract with E.coli resulted in a rapid increase in urine IL-8 levels without a detectable rise in IL-8 in serum. This study was conducted in Mansoura University Children's Hospital, and comprised 56 children with febrile urinary tract infection [UTI] and 10 matched healthy controls. Urine samples were taken from patients and control subjects and were analyzed by microscopic examination and bacterial culture. Urinary IL-8 measurements were performed for all samples. A significant increase in urinary IL-8 level was recorded in patients with febrile urinary tract infection compared to healthy controls [P<0.001]. The highest median urinary IL-8 level was found in febrile UTI with E.Coli, followed by staphylococcal infection. In conclusion, urinary IL-8 level may help in the diagnosis, and follow up of children with febrile UTIs

Extended Spectrum Beta-Lactamases among Gram-negative bacteria from an Egyptian Pediatric Hospital: a Two-Year Experience

Background Knowledge of the anti-microbial susceptibility pattern of common pathogens in a given area helps to inform the choice of empirical antibiotic therapy. The aim of this study was to determine the existence and to describe the characteristics of extended spectrum a-lactamase (ESBLs) in a pediatric hospital in Mansoura University; Egypt; to aid in the choice of empirical antibiotic therapy. Method: Between January 2005 and December 2006; blood samples were collected from children suspected to have nosocomial infections in a pediatric hospital in Mansoura. The gram negative isolates were identified; tested for antimicrobial susceptibility and analyzed for presence of ESBL. Results: A total of 1;600 children with suspected septicemia were studied. Gram negative septicemia was identified in 816 cases (45). The commonest isolated gram negative bacilli was Klebsiella species (38.2) followed by Enterobacter species (32.4); Serratia species (16.2) and Burkholderia cepacia (10.3). The highest susceptibility was for imipenem (74.3) followed by gentamicin (70.8); cefoperazone (64.5) and cefotaxime (63.2). The highest resistant rate was for cefazolin and ampicillin/sulbactam (75.5for each); followed by cefuroxime 70.3and ceftriaxone (63.5). The ESBL was found in 44.5for cefotaxime and 50for ceftazidime by double discs method. Conclusion: This study highlights the emergence of antibiotic resistant gram negative bacilli in a pediatric hospital with special emphasis on extended a-lactamase resistant strains. Our results show that the most appropriate antibiotics to be used for empirical therapy are amikacin and gentamicin

Relation of chlamydia pneumoniae IgG antibodies to serum interleukin-6 levels in patients with unstable angina and acute myocardial infarction

The aim of this study was to confirm the role of Chalmydia pneumoniae [C pneumoniae] infection in acute myocardial infarction [AMI] and unstable angina, to find possible relations between high levels of interleukin-6 [IL-6], C-reactive protein [CRP], lipid profile and C pneumoniae, and to interrelate these data with the pathogenesis of acute coronary syndromes. A group of 25 patients with AMI, a group of 25 patients with unstable angina, and 13 members of a healthy control group matched for age, sex, and main coronary risk factors were included in the study. In this study, sera were examined by an enzyme-linked immunosorbent assay [ELISA] for IgG antibodies to C pneumoniae. Also, we measured the levels of IL-6 by ELISA. Patients with AMI had highly significant increase in IL-6 levels and CRP levels compared with unstable angina patients [P < 0.001]. Patients seropositive to C pneumoniae had highly significant atherogenic changes in different parameters of lipid profile compared with patients seronegative to C pneumoniae [P < 0.001]. A very high significant linear correlation was found between IL-6 levels and CRP, high density lipoprotein-cholesterol [HDL-c], low density lipoprotein-cholesterol [LDL-C] levels in the AMI and unstable angina patients [tb = 0.649, - 0.466, 0.474 respectively]. A high significant linear correlation was found between IL-6 levels and triglyceride [TG] levels in AMI and unstable angina patients [tb = 0.326]. A good significant linear correlation was also found between IL-6 levels and total cholesterol in the AMI and unstable angina patients [tb = 0.269]. Patients seropositive to C pneumoniae had highly significant increase in CRP and IL-6 [P < 0.001] compared with patients seronegative to C pneumoniae. IL-6, a proinflammatory and prothrombotic cytokine, was significantly elevated in AMI and unstable angina particularly in patients with serological evidence of C pneumoniae. Also patients with C pneumoniae had an atherogenic lipid profiles with significantly elevated CRP levels as a part of acute phase response. These effects appear to be mediated by cytokines like IL-6, since a significant linear correlation was found between IL-6 and measured lipid parameters in this work