Mohamed O. Ahmed

Antibacterial In-Vitro Activities of Selected Medicinal Plants against Methicillin Resistant Staphylococcus Aureus from Libyan Environment

Medicinal plants are valuable natural sources effective against various infectious agents. Extracts from Libyan traditional medicinal plants were investigated for antibacterial activity. In this study, the potential antibacterial activity of extracts from eight Libyan traditional medicinal plants against methicillin-resistant Staphylococcus aureus (MRSA) was investigated in-vitro. Susceptibility assays using disc diffusion and broth microdilution test for the determination of minimum inhibitory concentration (MIC) were used to assess the antibacterial activity of methanolic extracts from medicinal plants. Extracts from all eight plants showed anti-MRSA activity with MIC values ranged between 25-50 mg/ml. Cistus salvifolius, Salvia officinalis, Pistacia atantica, Arbutus pavarii, and Myrtus communis exhibited the most potent anti-MRSA activity, whereas extracts from Teucrium polium, Thymus capitellatus, and Euphorbia dendroides showed weak anti-MRSA activity. Medicinal plants may serve as useful bactericidal agents and warrant further investigation to better evaluate their particular therapeutic potentials and optimize their application.

Misidentification of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals in Tripoli, Libya

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial (hospital-acquired) pathogen of exceptional concern. It is responsible for life-threatening infections in both the hospital and the community. Aims: To determine the frequency of MRSA misidentification in hospitals in Tripoli, Libya using current testing methods. Methods: One hundred and seventy S. aureus isolates previously identified as MRSA were obtained from three hospitals in Tripoli. All isolates were reidentified by culturing on mannitol salt agar, API 20 Staph System and retested for resistance to methicillin using the cefoxitin disk diffusion susceptibility test and PBP2a. D-tests and vancomycin E-tests (Van-E-tests) were also performed for vancomycin-resistant isolates. Results: Of the 170 isolates examined, 86 (51%) were confirmed as MRSA (i.e. 49% were misidentified as MRSA). Fifteen (17%) of the confirmed MRSA strains exhibited inducible clindamycin resistance. Of the 86 confirmed MRSA isolates, 13 (15%) were resistant to mupirocin, 53 (62%) were resistant to ciprofloxacin, 41 (48%) were resistant to trimethoprim-sulfamethoxazole, and none were resistant to linezolid. Although disc-diffusion testing indicated that 23 (27%) of the isolates were resistant to vancomycin, none of the isolates were vancomycin-resistant by Van-E-test. Conclusions: Misidentification of nosocomial S. aureus as MRSA is a serious problem in Libyan hospitals. There is an urgent need for the proper training of microbiology laboratory technicians in standard antimicrobial susceptibility procedures and the implementation of quality control programs in microbiology laboratories of Libyan hospitals.

Hepatitis C Virus in North Africa: An Emerging Threat

Hepatitis C virus is a major public health threat associated with serious clinical consequences worldwide. North Africa is a unique region composed of seven countries that vary considerably in the predisposing factors to microbial diseases both historically and at the present time. The dynamics of HCV in the region are not well documented. The data are both limited and controversial in most of the countries in the region. In North Africa, the epidemiology of HCV is disparate and understanding it has been hampered by regional “epidemiological homogeneity” concepts. As the dynamics of HCV vary from country to country, context-specific research is needed. In this review, we assess studies performed in each country in the general populations as well as among blood donors and groups exposed to the HCV infection. The reported prevalence of HCV ranges from 0.6% to 8.4% in the Maghreb countries and is predominated by genotype 1. In the Nile valley region, it ranges from 2.2% to 18.9% and is dominated by genotype 4. In North African countries, HCV seems to be a serious problem that is driven by different vectors even in different geographical locations within the same country. Efforts should be combined at both the national and regional levels to implement efficient preventive and treatment strategies.

Geographic integration of hepatitis C virus: A global threat

AIM To assess hepatitis C virus (HCV) geographic integration, evaluate the spatial and temporal evolution of HCV worldwide and propose how to diminish its burden. METHODS A literature search of published articles was performed using PubMed, MEDLINE and other related databases up to December 2015. A critical data assessment and analysis regarding the epidemiological integration of HCV was carried out using the meta-analysis method. RESULTS The data indicated that HCV has been integrated immensely over time and through various geographical regions worldwide. The history of HCV goes back to 1535 but between 1935 and 1965 it exhibited a rapid, exponential spread. This integration is clearly seen in the geo-epidemiology and phylogeography of HCV. HCV integration can be mirrored either as intra-continental or trans-continental. Migration, drug trafficking and HCV co-infection, together with other potential risk factors, have acted as a vehicle for this integration. Evidence shows that the geographic integration of HCV has been important in the global and regional distribution of HCV. CONCLUSION HCV geographic integration is clearly evident and this should be reflected in the prevention and treatment of this ongoing pandemic.

Detection of inducible clindamycin resistance (MLSB i ) among methicillin-resistant Staphylococcus aureus (MRSA) from Libya

Methicillin-resistant Staphylococcus aureus (MRSA) first emerged as nosocomial pathogens in the early 1960s are of great concern to public health and highly reported in human clinical samples. There are major international concerns about rising levels of MRSA and multi-drug resistant S. aureus owing to the difficulties of treating infections and the ease with which MRSA spreads within hospitals. Until recently, most infections of MRSA were acquired primarily in hospital settings, but now MRSA is responsible for both hospital and community-acquired infections. The objective of this study was to investigate MRSA collected isolates for MLSB phenotypes, in particular inducible clindamycin resistance (MLSB i ). (Published: 13 January 2010) Citation: Libyan J Med 2010, 5: 4636 - DOI: 10.3402/ljm.v5i0.4636

Mapping the travel route of African refugees who traverse Libya to determine public health implications for Libya and the North-African region

On December 13, 2015, Libya’s National Centre of Disease Control (NCDC), Ministry of Health issued an official statement confirming a single undefined case of malaria in a pregnant Libyan national residing in the southern region (NCDC 2015) [1]. This case (diagnosis based upon laboratory testing) followed the September publication of a Letter by Martelli et al. [2] on malaria in African emigrants who had traversed Libya during their immigration to Europe. The authors reported identification of two Plasmodium falciparum-positive carriers who were Malian immigrants who presented at Italian travel clinics following development of classic and general symptoms of malaria (i.e. pyrexia, cephalgia, arthralgia); antimalarial treatment led to full recovery for both patients. The years-long immigration routes of both patients began in the eastern region of Africa (i.e. Mali) and traversed various sub-Saharan and North African countries to reach the EU through Italy; both of the patients reported having resided in Libya for several years during their immigration. Martelli et al. [2] concluded that both of these immigrants acquired P. falciparum during the immigration travel period, likely during their extensive residence in Libya, classified as a non-malarious region. These two cases may represent the reappearance of malaria in Libya, as supported by the very recent reported case involving a Libyan national. Thus, it is important to explore the possible epidemiological route of this infectious disease to within Libya’s borders. Recent years have seen a drastic increase in African migrants traversing Libya. I

Spa typing and identification of pvl genes of meticillin-resistant Staphylococcus aureus isolated from a Libyan hospital in Tripoli.

OBJECTIVES The purpose of the study was to investigate the molecular characteristics of meticillin-resistant Staphylococcus aureus (MRSA) isolated from clinical sources in Tripoli, Libya. METHODS A total of 95 MRSA strains collected at the Tripoli medical Centre were investigated by spa typing and identification of the Panton-Valentine Leukocidin (pvl) genes. RESULTS A total of 26 spa types were characterized and distributed among nine clonal complexes; CC5 (n=32), CC80 (n=18), CC8 (n=17) and CC22 (n=12) were the most prevalent clonal complexes. In total, 34% of the isolates were positive for PVL. CONCLUSIONS This study demonstrated the presence of CA-MRSA and pvl positive strains in hospital settings and underlines the importance of using molecular typing to investigate the epidemiology of MRSA. Preventative measures and surveillance systems are needed to control and minimize the spread of MRSA in the Libyan health care system.

Multiplex PCR: a powerful and affordable tool for laboratory and field analysis in developing countries

To the editor,Since the introduction of multiplex-PCR(mPCR)in1988,this technique has emerged as a highly efficient and sensitive molecular tool for nucleic acid-based diagnosis and monitoring,it is applicable to a broad range of physiological,metabolic and infectious conditions affecting human,animal

The Epidemiology of Hepatitis D Virus in North Africa: A Systematic Review and Meta-Analysis

Background Hepatitis D virus (HDV) infection has been considered a serious neglected pandemic, particularly in developing countries. The virus causes a more severe disease than mono infection with hepatitis B virus (HBV). The epidemiology of HDV is not well documented in North Africa, which is known to be endemic for HBV. In this study, we explored the prevalence of HDV infection and also attempted to identify factors associated with hepatitis D positive status among chronic hepatitis B patients in North Africa. Methods The electronic databases PubMed, Embase, Scopus, Science Direct, Web of Science, and Google Scholar were comprehensively searched for all papers published between January 1, 1998, and December 31, 2017, using appropriate strategies containing all related keywords, including North Africa, names of countries in the region, and all permutations of hepatitis D virus. The estimated prevalence of HDV in North Africa was calculated as an average of the pooled infection prevalence in each country weighted by the ratio of the countrys hepatitis D virus population to the studys sample size in the survey data analysis. Findings A total of 312 studies were identified and 32 were included in this study, with a total sample of 4907 individuals screened for HDV. There was considerable variability in the prevalence estimates of HDV within the countries of the region. The overall prevalence of HDV in the general population of North Africa was 5·01% (95% CI: 1·25–8·27) and in liver disease patients it was 20.7% (95% CI:9.87–44.53). Genotype-1 was the most prominent genotype reported in five published studies. Ten studies reported on HDV RNA in participants who were seropositive for HDV, and four studies highlighted the impact of demographic factors (sex and age). No study showed the impact of risk factors on the prevalence of HDV in North Africa. Interpretation This review provides a comprehensive assessment of the burden of HDV in Northern Africa. There were significant differences in seroprevalence, study population, and diagnostic testing between the countries in the region. The results presented here will alert health professionals to implement clear policies based on evidence to diminish the burden of HDV infection. Such measures may include but are not restricted to improving the laboratory diagnostic tests and initiating patient data registries and blood screening. Further epidemiological and research studies are needed to explore the risk factors, coinfections, and approaches to increase testing for HDV, particularly in high-risk subpopulations, such as intravenous drug users and immigrants, and to define the consequences of HDV infection in North Africa.

Diarrheagenic Escherichia coli O157 from Libya: recent perspectives and challenges

Diarrheal pathogens persist as a primary cause of high morbidity − and mortality − gastrointestinal illnesses worldwide particularly in the developing world.1,2 Rotaviruses are a major cause of diarrheal illnesses, and a seasonal infection transmitted by the fecal-oral route. The increased incidence of rotavirus infection among human populations has been attributed to its wide-range presence in animals and ability to exchange genetic determinants between strains affecting animal and human hosts.3 Bacteria pathogens are also a leading cause of diarrhea, especially among children, and are reported to be responsible for significant morbidity, mortality, and economic losses, particularly in underdeveloped countries.2 In Libya, for instance, research studies of diarrheagenic agents have focused on bacteria and the pediatric population and different serogroups of Escherichia coli have been reported as a major cause of childhood diarrhoea.4-11 Entero-hemorrhagic E. coli [EHEC; also known by the acronyms Shiga toxinproducing E. coli (STEC), or verocytotoxin-producing E. coli (VTEC)] is one of the most common of the serogroups associated with gastroenteric illnesses and foodborne outbreaks.12 The Shiga toxins produced by this group of E. coli cause an array of complications in humans, ranging from uncomplicated diarrhea to life-threatening conditions such as hemorrhagic colitis, which can progress into hemolytic uremic syndrome (HUS) and severe acute renal failure. The STEC/VTEC encompass hundreds of serotypes capable of causing severe illnesses in humans, among which O157, O26, O111, O103 and O145 (the so-called top five) are the most frequently reported serogroups associated with human disease.13 The O157 serogroup is the most commonly reported and has been the main cause of serious outbreaks, especially of foodborne infections.12 As such, E. coli O157 has emerged as a particular public health concern. Ruminants, particularly cattle, are the natural reservoir of E. coli 0157, which inhabit the intestinal tract of healthy animals. Infection of humans is typically acquired through contaminated food and drink (i.e. undercooked ground meat, raw milk, dairy products, raw vegetables, contaminated fruits) or through direct contact with animals.12,14 Generally speaking, publications describing research on the frequency and occurrence of important zoonotic bacterial organisms of public health concern from underdeveloped regions, such as Libya, are few and epidemiological information remains scarce.5,14 However, researchers in Libya have begun reporting on the isolation of E. coli 0157 from a range of animals and animal products. Herein, we summarize the recent peer-reviewed articles on this topic and provide commentary to promote interest in this important public health concern and highlight the research opportunities (Table 1). In Libya, 24-33% of pediatric diarrheal cases are caused by rotavirus rotavirus.4,15,16 In addition, a recent study uncovered an alarming trend in increasing incidence, with these cases estimated to represent up to 57%.17 Bacterial pathogens are also reported to be a major cause of diarrhea in children and are responsible for an approximate 27% of the clinical samples examined. Several genogroups of E. coli have been characterized (i.e. EPEC, ETEC, EHEC, EIHC, EAEC) and found to express multidrug-resistant phenotypes.4,5,11 However, the epidemiology, phylogenetic relation and zoonotic features of the reported strains isolated from pediatric human cases, and at population level, are largely unknown. In Libya, the recently reported E. coli 0157 isolates from food-producing animals and most recently from animal products underscore the serious health concern facing this region (Table 1). Garbage et al., for instance, have reported the isolation of E. coli 0157 from raw milk and dairy products collected from different animals, with cow origin being predominant (7/11 of total isolates).18 This particular study has reported raw goat milk as the most contaminated source (i.e. 2/7 samples; 28.6%). On the other hand, Abujnah et al. have reported a high isolation rate for E. coli 0157 from fresh white cheese samples (35.6% of tested samples) collected from local factories around Tripoli; however, the animal origin of the samples was not clear.19 The consumption of raw or undercooked meat of bovine origin has been frequently reported to be the most common source of E. coli 0157 contamination and infection. A study of raw sausage specimens (locally known as almergaz) that had been collected from local markets in Tripoli isolated E. coli 0157 from 48%, with 60% genopositivity for stx genes among the isolated strains; however, the animal source of meat samples was not stated.20 Previously, studies have reported the isolation of this pathogen from burger meat specimens of beef and chicken origins. Considering the collective findings from these studies, the rates of isolation/contamination was found to range between 4-5% in cooked meat and from 20-27% in uncooked meat specimens of burgers (Table 1).21,22 Unfortunately, most of the previous studies have not determined the possible sources of these contaminant bacteria or the epidemiologic and phylogenetic relation among these strains and/or toward humans (either humans-incontact or the consumers). Prevalence of E. coli 0157 in healthy dairy cows has been studied as well. In suburban areas of Tripoli, the reported rates range from 6-9%.14,23 Shedding of E. coli 0157 from healthy cattle was reported to be significantly associated with signs of diarrhea and source of water-intake (identifying these parameters as risk factors of shedding). Surprisingly, age which is frequently associated with shedding of E. coli 0157, was not found to be a significant risk factor. Ultimately, healthy dairy cows have been posited as a natural reservoir of E. coli 0157 in Libya. A regional study from Egypt identified E. coli O157 isolates from marine life (seafood and animals from coastal water; 48% of tested samples).24 Thus, there is a Journal of Public Health in Africa 2017 ; volume 8:685