First report of MRSA from hospitalized patients in Sudan.
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Developing Countries↗
Biomedical subjects
P Shears
Publications and source records attributed to P Shears.
Antibiotic resistant Escherichia coli in a Sudanese hospital.
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Adult↗
Antimicrobial susceptibility of Shigella from a rural community in Bangladesh.
Of the 63 Shigella strains isolated from stool cultures from 200 patients who attended a district hospital in Bangladesh with bloody diarrhoea, 37 (59%) were S. dysenteriae type 1, 25 (39%) were S. flexneri and only one (2%) was S. sonnei. Over half (54%) of the Shigella isolates came from children aged < 10 years. Most (89%) of the isolates of S. dysenteriae type 1 were resistant to ampicillin, cotrimoxazole, nalidixic acid, tetracycline and chloramphenicol. Although many (60%) of the isolates of S. flexneri were resistant to ampicillin and cotrimoxazole, only 4% of them were resistant to nalidixic acid. However, all of the S. dysenteriae and S. flexneri were sensitive to ciprofloxacin. The need for periodic monitoring to determine the resistance pattern in remote areas is emphasised.
Adolescent↗
Occurrence in Sudan of Shigella dysenteriae type 1 with transferable antimicrobial resistance.
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Conjugation, Genetic↗
Community-acquired notifiable infectious diseases in a pediatric hospital: effect on infection control work load.
In a study of the impact of notifiable communicable disease admissions on infection control work load, we found notifiable disease cases to be responsible for less than 10% of admissions but 27% of infection control ward visits and to require extensive community liaison. Measures of work load based on nosocomial infections alone will underestimate infection control activity considerably.
Child↗
Isolation and characterization of coliforms from glacial ice and water in Canada's High Arctic.
Ellesmere Island is the northern most member of the Canadian Arctic Archipelago with over one-third of the land mass covered by ice. A joint services expedition to the island's Blue Mountains offered a unique opportunity for microbiological studies of resident bacteria in an environment uninhabited by man. Over 100 samples of water and ice were collected from stream, lake and glacier and the filtrate cultured under canvas. Bacterial growth was harvested onto swabs for transport back to the UK and 50 coliforms chosen at random for identification and antibiotic susceptibility testing. Most of the glacial strains were capsulated, pigmented and some over 2000 years old. Genera such as Serratia, Enterobacter, Klebsiella and Yersinia were found; speciation was inconclusive and some organisms remain unidentified. Ampicillin resistance was evident in 80% of water isolates as opposed to 30% of the glacial organisms, but the isolates were generally exquisitely susceptible to antibiotics. The facility for ampicillin resistance did not appear to be transferable. Plasmid DNA was found in 33% of the glacial organisms and over 50% of the water isolates. Similar profiles were identified within and apparently between species and required plasmid restriction analysis to help establish identity. Plasmid-free Serratia spp. were subjected to genomic fingerprinting. Indistinguishable patterns were found within sets of isolates both widely spaced by distance and collection date and it was postulated that coliforms able to survive an Arctic environment had spread extensively throughout the expedition area. In conclusion, this study contributes towards knowledge of naturally occurring antibiotic resistance, confirms the presence of plasmids and genotypic data provided evidence that potentially ancient organisms from glaciers can be cultured from water samples significantly distant.
Anti-Bacterial Agents↗
Tuberculous pericarditis in a child.
A 14-year-old boy with tuberculous pericarditis and tamponade is described. Confirmation was by culture of pericardial aspirate. Though he did not have a cough, acid-fast bacilli were detected following induced sputum. Chest X-ray did not show evidence of pulmonary tuberculosis, but enlarged mediastinal nodes were detected by computerized tomography. He made an excellent response to anti-tuberculous chemotherapy and corticosteroids.
Adolescent↗
Shigella infections.
Shigella dysentery is a major public-health problem in many tropical areas. Despite improvements in water supplies and sanitation, it continues to be a disease of poor rural and urban communities and in populations affected by migration and crowding following disasters. Pathogenesis is due to colonic invasion, endotoxin, and, in Shigella dysenteriae 1, shiga toxin. As well as the local manifestations of dysentery, systemic complications include convulsions, haemolytic-uraemic syndrome, hyponatraemia and hypoglycaemia. The spread of shigella infection is most commonly person-person, although water and food-borne outbreaks have been reported. Since 1970, multiple antimicrobial resistance, particularly in Sh. dysenteriae 1, has complicated strategies for management. Multiply resistant strains have occurred in Latin America, Central Africa and southern and south-eastern Asia. No vaccines are currently available, and prevention and control will depend on public-health improvements and improved case management.
Drug Resistance, Microbial↗
Community-acquired infections among children in an urban environment: a 2-year prospective study in Liverpool, U.K.
Community-acquired infections are an important cause of admission of children to hospital. We have made a 2-year prospective study of 1,599 children admitted with infection to the Royal Liverpool Children's Hospital in order to determine the pattern of infections, their seasonal distribution and the role of the laboratory in isolating causative agents. Respiratory infections (32% cases) and gastroenteritis (28% cases) were the principal causes of admission. Of all admissions, 64% were children aged less than 1 year. Appropriate specimens were obtained and/or investigations made of 48% cases. Overall, a causative agent was determined in 21% cases. Individual pathogens showed marked seasonality. Respiratory syncytial virus, rotavirus and Shigella species were found more often in the winter months, while Salmonella species and adenovirus infections were most common in the summer. The results provide local data that is relevant to both public health and hospital planning. They also emphasise the need for continuing surveillance of community-acquired infections.
Child, Preschool↗
Water sources and environmental transmission of multiply resistant enteric bacteria in rural Bangladesh.
The role of different water sources in the spread of multiply resistant enteric bacteria was investigated in rural Bangladesh. The prevalence of resistance to commonly used antimicrobial agents in the faecal flora of village children and the water quality and prevalence of resistance in village water sources were studied. Most of the children studied (81%) had multiply resistant faecal coliform bacteria, i.e. bacteria resistant to at least three antimicrobials. Although tubewells provided water with low faecal coliform counts, 62% of household storage pots contained water with moderate to high counts. Most of the storage pots (76%) and each of the river and pond sites tested contained multiply resistant isolates. Contamination of water within the household, and the widespread distribution of resistant coliforms in the environment, contribute to the high prevalence of multiply resistant enteric flora in the community. These findings are of importance in understanding the spread of multiply resistant enteric pathogens.
Ampicillin Resistance↗
A pseudo outbreak of tuberculosis.
Three cases of suspected tuberculosis were diagnosed over a ten day period at an oncology unit. Case finding was carried out and six further cases were diagnosed. However, doubts were raised about these diagnoses and a review of the outbreak investigation was carried out. Investigation of laboratory procedures found that the 'outbreak' was likely to be due to a contaminated phenol red solution. This incident highlights the importance of a critical evaluation of outbreak investigations, and the need for close collaboration between clinicians, epidemiologists and laboratory staff.
Child↗
Genomic characterization of rotavirus strains obtained from hospitalized children with diarrhoea in Bangladesh.
Faecal samples were obtained from 111 children hospitalized with acute watery gastroenteritis in a children's hospital in Bangladesh from January to December, 1989. Rotavirus was detected as the aetiologic agent in 35 (32%) of these patients. The electrophoretic pattern of ds-RNA extracted from the rotaviruses showed 11 different migration patterns (six short and five long), as well as some short and long mixed profiles. All four major G serotypes were identified by amplification of a segment of the gene for VP7 using the polymerase chain reaction. A specific serotype could be assigned in 32 (91%) cases. Serotypes G1-G4 accounted for 11%, 37%, 11%, and 23% of isolates respectively. Three (9%) mixed serotypes were identified by this method and were found to be mixtures of serotypes G1 and G4, G2 and G4, and G3 and G4.
Adolescent↗
Cholera.
Although it is more than a century since the discovery of the vibrio bacillus, cholera remains one of the great epidemic diseases of the tropical world. The epidemiology of cholera is an interaction between the biological and ecological properties of Vibrio cholerae and the complex patterns of human behaviour in tropical environments. The seventh pandemic has spread through all areas of the tropics, and cholera has become endemic in many new areas. The view that cholera was primarily water borne and that humans were the only long-term reservoir has been challenged by the discovery that V. cholerae can survive, often in a dormant state, in aquatic environments. The recent appearance of V. cholerae 0139, a new serotype that causes a disease clinically and epidemiologically indistinct from cholera, has further complicated our understanding of this ancient disease. Developments in the molecular characterization of V. cholerae are providing new information to explain the genetic and epidemiological variations.
Cholera↗
Application of pyrolysis mass spectroscopy and SDS-PAGE in the study of the epidemiology of Pseudomonas cepacia in cystic fibrosis.
Representative isolates of Pseudomonas cepacia from 15 cystic fibrosis (CF) patients attending the Respiratory Unit of Alder Hey Childrens' Hospital were investigated by SDS-PAGE of whole-cell polypeptides and by pyrolysis mass spectroscopy (PMS). SDS-PAGE was less discriminatory than PMS. Eleven isolates were indistinguishable by PMS and considered to represent re-isolates of an endemic strain; four isolates were distinct from this group, and from one another. P. cepacia was first isolated on the unit in July 1989 from a patient who had attended a UK selection meeting for a Canadian CF camp. A ward and outpatient segregation policy was introduced, but colonisation of further patients occurred. In August 1991, the Adult CF Association recommended that all social activities involving colonised patients should cease. This, and an increased awareness amongst older CF patients of the risks of person-to-person transmission, was associated with a marked decline in new cases. Social activity and hospital admissions were compared for colonised patients during the year before colonisation with P. cepacia, and matched patients who did not acquire the endemic strain. This showed a significantly higher attendance at CF social events for colonised patients, but no significant association between colonisation and hospital admission. These results are strong indirect evidence that transmission of P. cepacia occurs through social contact outside the hospital environment.
Adolescent↗
Effect of pH and CO2 on in vitro susceptibility of Pseudomonas cepacia to beta-lactams.
Inhibition of Pseudomonas cepacia (but not Pseudomonas aeruginosa) by beta-lactams was decreased in 5% CO2 in air compared with air alone. The effect of CO2 and pH (range, 6.0 to 8.0) on beta-lactam susceptibility, beta-lactamase expression, and outer membrane proteins was studied in isolates recovered from the sputum of children with cystic fibrosis. Incubation in 5% CO2 decreased the activity of piperacillin, piperacillin/tazobactam, and ceftazidime, although isolates were still clinically sensitive (minimum inhibitory concentrations < 16 mg/L). Cefpirome activity was markedly decreased from a minimum inhibitory concentration of 2.0 to greater than 64 mg/L. On highly buffered 3-(N-morpholino)-propane sulfonic acid media, beta-lactam susceptibility was eliminated at pH greater 7.5. A 2- to 13-fold increase in beta-lactamase activity was demonstrated after growth in 5% CO2 compared with basal aerobic levels for 13 of 15 clinical isolates. beta-Lactamase activity did not vary significantly with pH. Addition of imipenem to media (2.0 mg/L) resulted in hyperproduction of beta-lactamase (180-fold). Isoelectric points varied with cultural conditions, and all beta-lactamases detected were inhibited by clavulanate and tazobactam. Significant hydrolysis of piperacillin and ceftazidime could not be demonstrated. A 36-kD porin was present at all pH tested. Thus, our strains of Pseudomonas cepacia were markedly affected by cultural conditions not normally used in standardized susceptibility tests. However, such conditions may be encountered in the pathologically altered infected lung in cystic fibrosis.
Anti-Bacterial Agents↗
Cryptosporidium in Khartoum, Sudan.
Diarrhoea caused by the protozoan parasite Cryptosporidium has been shown in several tropical countries to be an important health problem, particularly in children. Although infection is often associated with contact with animals, it may also occur through person to person transmission and via contaminated water or food. We have undertaken a cross sectional study to determine the prevalence of Cryptosporidium in children with diarrhoea and in their family contacts, and also investigated its occurrence in adult food handlers. Sixteen of 100 children with diarrhoea and none of the controls, were positive for Cryptosporidium. In addition, seven children had one or more sibs with diarrhoea who also excreted Cryptosporidium. None of the food handlers or asymptomatic children were positive. The results confirm earlier findings that Cryptosporidium is an important cause of diarrhoea in children in Sudan, and suggest that intrafamilial spread occurs.
Carrier State↗
The prevalence and genetics of resistance to commonly used antimicrobial agents in faecal Enterobacteriaceae from children in Bangladesh.
The present study was undertaken to investigate the occurrence of antibiotic resistance in enteric flora in 64 children in rural Bangladesh over a 12-month period. The antibiotic resistance pattern of the isolates varied throughout the year and multiple resistance was highest during the post monsoon period. Seventy-three percent of children had isolates resistant to more than three antibiotics throughout the year. Resistance to streptomycin was highest (78%), followed closely by ampicillin (72%). Of 82 multiply resistant isolates, plasmid DNA was demonstrated in 75%. Plasmid sizes ranged between 3.7 and 110 MDa, the commonest plasmids were of 70, 98 and 110 MDa. Complete or partial resistance was transferred by conjugation from 52% of the isolates, most frequently by single plasmids. The commonest plasmid incompatibility group was F11-A (46%) followed by incompatibility group P (22%). Plasmids of molecular weight 98 MDa most often hybridized with F11-A probes and those of 110 MDa with H11 probes. Plasmids from 10 transconjugants were digested with restriction enzymes and digest patterns demonstrated the presence of common plasmids. The findings show that there is a diverse, and mobile, genetic pool of resistance genes in this rural community. This genetic reservoir is potentially transferable to enteric pathogens, with major implications for public health and diarrhoeal disease control.
Bangladesh↗