Fatma A. Amer

Occurrence of classes I and II integrons in Enterobacteriaceae collected from Zagazig University Hospitals, Egypt

Integrons are genetic units characterized by the ability to capture and incorporate gene cassettes, thus can contribute to the emergence and transfer of antibiotic resistance. The objectives of this study were: (1) to investigate the presence and distribution of class I and class II integrons and the characteristics of the gene cassettes they carry in Enterobacteriaceae isolated from nosocomial infections at Zagzig University Hospital in Egypt, (2) to determine their impact on resistance, and (3) to identify risk factors for the existence of integrons. Relevant samples and full clinical history were collected from 118 inpatients. Samples were processed; isolated microbes were identified and tested for antibiotic susceptibilities. Integrons were detected by polymerase chain reaction (PCR) and were characterized into class I or II by restriction fragment length polymorphism (RFLP). Integron-positive isolates were subjected to another PCR to detect gene cassette, followed by gene cassette sequencing. Risk factors were analyzed by logistic regression analysis. Seventy-six Enterobacteriaceae isolates were recognized, 41 of them (53.9%) were integron-positive; 39 strains carried class I and 2 strains carried class II integrons. Integrons had gene cassettes encoding different combinations and types of resistance determinants. Interestingly, blaOXA129 gene was found and ereA gene was carried on class I integrons. The same determinants were carried within isolates of the same species as well as isolates of different species. The presence of integrons was significantly associated with multidrug resistance (MDR). No risk factors were associated for integron carriage. We conclude that integrons carrying gene cassettes encoding antibiotic resistance are significantly present among Enterobacteriaceae causing nosocomial infection in our hospital. Risk factors for acquisition remain to be identified.

The 17th International Congress on Infectious Diseases workshop on developing infection prevention and control resources for low- and middle-income countries

Summary Hospital-acquired infections (HAIs) are a major concern to healthcare systems around the world. They are associated with significant morbidity and mortality, in addition to increased hospitalization costs. Recent outbreaks, including those caused by the Middle East respiratory syndrome coronavirus and Ebola virus, have highlighted the importance of infection control. Moreover, HAIs, especially those caused by multidrug-resistant Gram-negative rods, have become a top global priority. Although adequate approaches and guidelines have been in existence for many years and have often proven effective in some countries, the implementation of such approaches in low- and middle-income countries (LMICs) is often restricted due to limited resources and underdeveloped infrastructure. While evidence-based infection prevention and control (IPC) principles and practices are universal, studies are needed to evaluate simplified approaches that can be better adapted to LMIC needs, in order to guide IPC in practice. A group of experts from around the world attended a workshop held at the 17th International Congress on Infectious Diseases in Hyderabad, India in March 2016, to discuss the existing IPC practices in LMICs, and how best these can be improved within the local context.

Epidemiology of Hepatitis C Virus Infection in Egypt.

Hepatitis C virus constitutes an epidemic in Egypt having the highest prevalence in the world of 14.7%. The reasons behind this unique epidemic may be dated back to iatrogenic role of parenteral antischistosom al therapy campaigns to control endemic schistosomiasis. Other routes of infection are contributing to the ongoing HCV transmission. The prevalent genotype in Egypt is type 4 (73%), the origin, evolution, and dynamics are difficult to determine. Risk facto rs for acquiring HCV infection include: History of antischistosomal injection treatment before 1986, old age, male gender, and residence in rural areas. Other risk factors include; injection therapy, blood transfusion prior to 1994, exposure to various facility - based medical procedures, and occupational transmission among health care workers. In community settings, a set of risk factors, mostly related to prevailing social and cultural conditions, are responsible for maintaining the high rates of HCV tra nsmission. Chronic HCV is the main cause of liver cirrhosis and liver cancer in Egypt and, indeed, one of the top five leading causes of death. It kills an estimated 40,000 Egyptians a year. Mini - review Article

Clostridium difficile Occurrence, Toxin Profile and Antibiotic Susceptibility: An Egyptian Center Experience

Background: Clostridium difficile (C. difficile) infection (CDI) is of concern in healthcare facilities. The role of binary toxin alone is controversial. Resistance to antibiotic therapy has emerged. Objectives: to determine the occurrence of C. difficile, their toxigenicity, antibiotic susceptibility pattern and the effect of binary toxin gene. Methodology: A cross section study, stools samples were collected from 211 patients. Strains were identified, antibiogram was determined using ATB TM ANA, and E-test for vancomycin. A multiplex PCR assay for (tpi), tcdA and tcdB genes, followed by a duplex PCR for cdtA and cdtB genes were done. Results: C. difficile was isolated from 29 samples (13.7%).. One strain was resistant to metronidazole, and three had intermediate susceptibility. All isolates were positive for (tpi) gene. Fifteen isolates (51.7%) were non toxigenic and 14 (48.2%) were toxigenic. Three toxigenic isolates harbored binary toxin genes. It was not possible to identify any impact of binary toxin due to small number found to harbor it. Conclusions : C. difficile is not a major problem in our locality. Further studies are needed to detect the role of binary toxin. Proper infection control measures and rationale use of antimicrobials are mandatory to prohibit further exaggeration of the problem.

Immunological mechanisms controlling hepatitis C virus infection

Hepatitis C virus (HCV) infection is a significant global health problem, affecting over 150 million people worldwide. There is increasing evidence that a small percentage of individuals exposed to the HCV have the capacity to generate a strong cellular as well as humeral immune response against the virus and avoid persistent infection, and perhaps do so repeatedly after re-exposure. While the critical role of the adaptive immune system in HCV infection is well-established, the importance of the innate immune system has been recognized in more recent years. The immune system has many weapons to combat the HCV infection. These include type I interferons, HCV specific CD4+ cells and CD8+ T cells, cytokine production, natural killer cells, dentritic cells, and the production of anti-HCV neutralizing antibodies. Toll-like receptors form an important element of the innate immune response, and there is considerable evidence for their crucial role in HCV infection. In order to limit the availability of the cellular components for viral amplification, apoptosis occurs. It involves caspases, the key effectors of apoptotic cell death. This article reviews what the immune system does, when HCV attacks the body.