ABSTRACT
This study was performed on 317 patients attended to pediatric and ENT- Outpatient Clinics at Al-Azhar University Hospital of Assiut during 2 years from 2009-2011, samples were collected from middle ear fluid, 161 patients were males and 156 were females, patients were of different ages ranges from 6 months to 75 years old, children under 10 years represented 53.3% [169] of total patients in this study. The objectives were to determine the macrolide resistance of isolated Strept. pneumoniae. Out of the 317 cases of otitis media, 78 isolates of Strept. pneumoniae were obtained [24.6%]. Out of them 66 isolates were from 196 cases of acute otitis media [33.7%] and 12 isolates were from 121 cases of chronic otitis media [9.9%]. There were 45 isolates from males, while 33 were from females. Most isolates were taken from patients under 10 years old [51 isolates]. Sensitivity pattern of Streptococcus pneumonia showed that 30.7%, 26.9% and 24.4% were resistant to erythromycin, clarithromycin and azithromycin respectively. As previous findings proved that pneumnococci resistant to erythromycin have mainly one or both distinct resistance determinants either erm[B] or mef[E]. PCR was done to detect these genes in isolates [24] erythromycin resistance, it was observed that 33.3% harbored mef genes, 8.3% erm genes and 41.6% both mef and erm genes. erm B and mef E genes were detected using agarose gel electrophoresis at 224 and 347 bp respectively
Subject(s)
Humans , Male , Female , Streptococcus pneumoniae/isolation & purification , Macrolides , Drug Resistance, MicrobialABSTRACT
Background: The pathogenesis of renal scarring following acute pyelonephritis [APN] remains unclear
Objectives: We sought to investigate the implication of the common polymorphisms in the renin-angiotensin system [RAS] genes, and other risk factors, in the development of renal scarring following APN in Egyptian children
Methods: 414 patients with culture-confirmed urinary tract infection were examined by DMSA-scans for diagnosis of APN and voiding cystourethrogram to test for vesicoureteric reflux [VUR]. Genetic polymorphisms at three RAS genes [ACE I/D, ATR-1 A1166C and AGT M235T] were analyzed by PCR and DNA sequencing in APN patients and 140 control children. Follow up DMSA-scans were performed 6-9 months later to detect renal scarring
Results: APN was diagnosed in 63 patients [34 boys and 29 girls] aging 2 months-12 years. Renal scarring was detected in 40 patients. VUR was the only independent risk factor for renal scarring [P=0.01]. The D-allele of ACE gene was significantly more frequent in the scarring group [76.25%] compared to non-scarring group [57.8%] and controls [56.7%]; P=0.035 and 0.003, respectively. However, the frequencies of ATR-1 and AGT genotypes and alleles in scarring and non-scarring groups did not show significant difference. The ACE I/D polymorphism was significantly and tightly associated with renal scarring [OR=2.6, CI=1.04-4.94, P=0.039]. In contrast, AGT and ATR-1 polymorphisms could not be associated with renal scarring after APN [P=0.108 and P=0.821, respectively]
Conclusion: VUR is an independent risk factor for renal scarring following APN. The ACE D allele may be one of the genetic susceptibility factors contributing to adverse renal prognosis in Egyptian children
ABSTRACT
Background: staphylococcus enterotoxins [SEs] are super antigenic toxins responsible for food poisoning in human and lead to high incidence of food poisoning outbreaks. The only previously known toxins were the five major classical types SEA to SEE. New types have been identified such as SEG and SEH. Objective: The aim of this work was to evaluate the percentage of S. aureus and enterotoxin productivity in milk and some dairy products, and to characterize the genes encoding some of the classical and the most newly described types of SEs
Materials and methods: 400 samples [200 milk, 100 ice-cream and 100 kariesh cheese samples] in addition to 50 human nasal swabs from handlers of these products were collected from different localities in Assiut Governorate, Egypt and were examined for the presence of S. aureus strains using Baird-Parker agar[BP-A]. Suspected colonies were confirmed as S. aureus by tube coagulase test and detection of clumping factor, protein A and capsular polysaccharides by latex agglutination test. Confirmed S. aureus isolates were examined for the production of SEs by using sodium dodecyl sulphate-polyacrylamide gel electrophoresis [SDS-PAGE]. Enterotoxigenic strains were examined for the presence of SE genes by polymerase chain reaction [PCR] using specific primers for SEA, SEB, SEC, SED, SEG and SHE
Results: confirmed S. aureus isolates were detected in 50% of raw milk, 35% of ice-cream and 65% of kariesh cheese samples and 40% of nasal swabs. Collectively, 50% of S. aureus isolates were enterotoxigenic and the highest percentages were detected in milk taken directly from animals [68. 7%] and kariesh cheese from street distributers [65. 7%]. In milk and dairy products, the major classical enterotoxin genotype was SEA which was detected in 29.3% of toxigenic isolates. SEC was detected in 16.1% and SED in 10.1%. SEB could not be detected. For the newly described genes, SEG was detected in 10.1% and SEH in 7.1%. Mixed forms were found in 2 3.2% of toxigenic isolates and four strains [4. 04%] carried undescribed genes. In nasal swabs, the most common type of SEs was SEA [40%] other types except SEB were detected separately in 10% of toxigenic isolates. The mixed forms were found in 20% of toxigenic isolates
Conclusions: a large proportion of raw milk and some dairy products [especially kariesh cheese] exposed for sale in Assuit City, Egypt are contaminated with enter toxigenic S. aureus. The most common type in both milk and dairy products as well as in nasal swabs was SEA which is known to be less common among strains from animal origin than from human. Nasal carriage in human food handlers is considered a primary source of contamination of milk and dairy products
ABSTRACT
Beta- thalassemia syndromes are the most common causes of chronic haemolytic anemia in Egypt. The disease appears early in life as a Variable degree of anaemia associated with splenomegaly, stunted growth, bone changes and mongoloid facies. Patients are usually treated with regular blood transfusion which leads to iron overload and therefore chelation therapy is very important to avoid iron overload and its complications. The patients may have immunological abnormalities mostly due to iron overload, repeated exposure to allogenic antigens and immunosuppressive viruses in blood transfusions, desferrioxamine chelation therapy and splenectomy. Infection has been reported to be one of the main causes of morbidity and mortality in beta-thalassemia. It is described as the second most common cause of death in these patients with a prevalence of 12-13%. Besides the well-known risks of blood-borne infections associated with multiple transfusions, a less familiar clinical problem is the increased susceptibility of these patients to infections, due to the coexistent immune deficiency. One of these infections may be parvovirus B19. Parvovirus B19 is a single-stranded DNA virus. The virus is classified as a member of the erythrovirus genus because replication occurs only in human erythrocyte precursors. This work was designed to study some transfusion related viral infections in thalassemic children attending the hematology unit of Pediatrics department of Assiut University and to discuss the possible predisposing and underlying factors. The study was carried out in the period between September 2004 and October 2005 in the departments of clinical pathology and pediatrics, Assiut university hospital, Egypt It included 50 individuals, 35 transfusion-dependant children with beta-thalassemia major, aged 2 to 15 years and 15 apparently healthy children as a control group. Patients recruited in the study had thorough history taking and complete clinical examination. In addition, the following laboratory investigations were performed for all cases and controls: complete blood picture including reticulocytic count and calculation of the reticulocytic index; liver functions, [iron status [including serum iron, TIBC and ferritin]; human parvovirus B19 IgG; Hepatitis C virus antigen by PCR and antibodies [HCV-Abs] by ELISA, hepatitis B virus surface antigen [HBsAg], and human immunodeficiency virus types 1 and 2 antibodies by ELISA. Thalassemic patients had significantly lower Hb, RBCs and TIBC and significantly higher reticulocytic count, reticulocytic index, serum iron, serum ferritin, serum bilirubin, AST and ALT than the controls. The studied patients had 83% positivity for Parvovirus lgG antibodies, 97% for Hepatitis C IgG antibodies, 80% for Hepatitis C antigen by PCR. Patients had significantly lower CD4 T lympocytes, higher CD8 T lymphocytes than the controls. CD4/CD8 ratio was also inverted in the patients. Parvovirus positive cases had significantly lower Hb, RBCs, reticulocytic count and index and significantly higher AST and ALT than parvovirus negative cases. Serum ferritin, parvovirus IgG, and CD8 T lymphocytes correlated positively with the number of blood transfusions. Parvovirus lgG correlated positively with AST and ALT and negatively with reticulocytic count. Infectious complications constitute an important part of the clinical spectrum of beta-thalassemia, being associated with significant morbidity and mortality. The recently recognized immune defects in these patients involve multiple components of the immune system and have been attributed to specific features of the disease, as well as to the therapeutic modalities applied. Iron overload, a primary complication of both thalassemia itself and transfusion therapy, is thought to be the main precipitating mechanism, due to the important immunoregulatory properties of iron and its binding proteins. Iron excess may derange the immune balance in favor of the growth of infectious organisms. Other factors include multiple transfusions, associated with constant allo-antigenic stimulation, as well as with transmission of immunosuppressive viruses including the parvovirus B19. Infection with this virus in thalassemic patients can lead to persistent anemia indicated by reticulocytpenia and decreased reticulocytic index. Surveillance for infections in patients with beta-thalassemia is crucial, while additional studies are required to establish more clearly the clinical significance of the suspected precipitating mechanisms, hence providing new methods for the further amelioration of the survival rate and quality of life. Blood or blood products intended for use in high-risk groups such as immunocompromised individuals and patients with underlying hematological problems should be screened for B19. New inactivation methods for blood or blood products should be implemented to reduce the transmission of the parvovirus B19 via blood transfusion. Screening of blood donors for B19 can be an alternative to viral inactivation. Regular chelation therapy is a must to prevent the effects of the iron overload on the immune response. lntroduction of parvovirus B19 vaccines particularly for the immunocompromised patients may be helpful in the near future