Adolescents' expectations with regard to school health services in Sfax, Tunisia

Adolescent health poses new kinds of problems which are difficult to handle and solve through traditional school health centres and structures. In order to identify the expectations of adolescents with respect to their health centres, an epidemiological survey was carried out by means of a self-administered questionnaire to a representative sample of 625 high school students in Sfax, Tunisia. The principle results demonstrated that 54% of those questioned were not satisfied with the available services offered by their school health centres. Their expectations concerned physician availability, the quality level of the exchange, in particular with regard to being listened to (85%), dialogue (82%), a clear understanding of the real problems and issues (82%), as well as information (51%), discussion and consultation in the event of health problems (61%) and the quality of bedside manner (50%). Such results indicate the need for an orientation of the work of school health care staff towards a psycho-social approach centred on the individual students and which dedicates more interest to their needs, perceptions and participation.     

Bacteriology of community acquired meningitis in Sfax, Tunisia (1993-2001)

OBJECTIVE: The aim of this study was to analyze the distribution of bacteria responsible for community-acquired meningitis and the pattern of resistance of common species. DESIGN: All bacteriologically confirmed cases of community-acquired meningitis were recorded between 1993 and 2001. RESULTS: Two hundred twenty-four cases of bacterial meningitis were recorded. The most frequent species were Haemophilus influenzae and Streptococcus pneumoniae followed by Neisseria meningitidis with respectively 37.1%, 32.1%, and 10.7% of cases. The yearly distribution of these bacteria did not show any epidemic peak. Enterobacteria and group B Streptococcus were the most frequently identified pathogens in neonatal meningitis. H. influenzae was the predominant microorganism in children between one month and five years of age, (66.4%) followed by S. pneumoniae (23.5%). S. pneumoniae was the predominant bacteria responsible fore more than half of the cases over five years of age. 28.8% of H. influenzae strains produced beta-lactamase. 27.2% of S. pneumoniae strains were less susceptible to penicillin. Resistance rates for amoxicillin and cefotaxime were respectively 10.6% and 7.5%. Only one strain of N. meningitidis (4.2%) presented with a decreased susceptibility to penicillin. CONCLUSIONS: In our study, H. influenzae and S. pneumoniae were the main microorganisms responsible for community-acquired meningitis. High resistance rates were found for these bacteria: 28.8% of H. influenzae to ampicillin and 27.2% of S. pneumoniae to penicillin.     

Resistance to third generation cephalosporins in Sfax hospitals, Tunisia (1999-2005)

OBJECTIVES: The authors wanted to assess the prevalence and to monitor the trends of resistance to broad-spectrum cephalosporins among various species of enterobacteria in the region of Sfax (Tunisia). METHODS: A retrospective study was carried out in the microbiology laboratory at the Habib-Bourguiba Teaching Hospital in Sfax. Data concerning a seven-year period (1999-2005) were analyzed with the Whonet 5.4 software. All clinical isolates of enterobacteria were identified with the API 20 E system. Antimicrobial susceptibilities were determined by disk diffusion on Mueller Hinton agar according to CA-SFM recommendations. RESULTS: During the study period, 24,702 non-duplicate clinical strains of enterobacteria were identified. Fifteen percent (3,826) clinical isolates showed acquired resistance to third generation cephalosporins (3rdGC). The overall frequency of resistance increased from 10% in 1999 to 18% in 2005. This increase was statistically significant. High prevalence rates of 3rdGC resistance have been observed in intensive care units (48%), hematology and oncology wards (27%) and pediatric wards (25%). Klebsiella pneumoniae, Indole positive Proteus and Enterobacter showed high prevalence rates of broad-spectrum cephalosporin resistance. CONCLUSION: This study revealed a high rate of 3rdGC resistance enterobacteria in our region, particularly in intensive care units. The frequency of acquired resistance to broad-spectrum cephalosporins seemed to be increasing. Implementation of infection control measures and identification of the mechanism responsible for third generation cephalosporins resistance are necessary to limit the spreading of these resistant enterobacteria in hospitals and community settings.     

Epidemiological study of Enterobacteriaceae resistance to colistin in Sfax (Tunisia)

Objectives

The authors had for aim to monitor Enterobacteriaceae resistance to colistin, during 6 years (2005–2010), and to study the epidemiology of Enterobacteriaceae resistant strains isolated in the Sfax region (Tunisia).

Design

This retrospective study was carried out in the microbiology laboratory, at the Habib Bourguiba teaching hospital in Sfax. All strains of colistin resistant Enterobacteriaceae isolated from patients were studied.

Results

One hundred and twenty one strains of colistin resistant Enterobacteriaceae were isolated from 93 patients. Klebsiella pneumoniae was the most frequent species (60.2%), followed by Enterobacter cloacae (26.9%), and Escherichia coli (12.9%). Thirteen strains (E. cloacae) were heteroresistant to colistin. Eighty one isolates (87.1%) were resistant to third generation cephalosporins. The rate of resistance to colistin ranged from 0.09% for E. coli to 1.2% for K. pneumoniae, and 1.5% for E. cloacae. A progressively increasing colistin resistance was observed for K. pneumoniae. Most resistant strains were isolated from urine in the urology department. Previous exposure to colistin was reported in 59.2% of patients. Pulsed field gel electrophoresis typing revealed different clones.

Conclusions

Colistin resistance in Enterobacteriaceae is a worrying phenomenon in Sfax. It is related to polyclonal diffusion. Continuous epidemiological monitoring and a rational use of colistin are necessary to limit the spreading of these colistin resistant strains and to maintain this antibiotic's effectiveness.     

福建省艾滋病感染的流行病学和病毒亚型 之间相互关系的研究

目的通过分子流行病学调查,明确福建省人类免疫缺陷病毒-1(HIV-1)流行毒株亚型与艾滋病(AIDS)流行的关系.方法通过艾滋病监测网络发现全省HIV/AIDS病例,应用核苷酸序列分析技术确定HIV-1亚型,结合流行病学资料分析福建省AIDS的流行状况.结果截至2000年底,全省累计发现188例HIV感染者,其中AIDS59例(已死亡53例).经异性性接触感染占65.4%,经血途径感染占9.0%,境外感染占44.1%,其中在东南亚等国家感染约占83.1%,境内感染占39.9%.41例HIV/AIDS病例的HIV-1亚型分析表明福建省存在A、B、C和E4种亚型,E亚型占75.6%(31/41),均为经异性性接触途径感染;B亚型17.1%(7/41),主要经血途径感染.A和C亚型分别为1和2例.E亚型基因离散率为(12.245±3.894)%,B亚型基因离散率为(10.762±2.707)%.表明福建省E亚型流行株的来源复杂,与感染地点、时间有关.结论福建省AIDS流行速度正在加快,病毒感染者主要经异性性接触途径感染,HIV-1流行毒株主要为E亚型.     

贵州省HIV-1毒株基因亚型变异特征分析

目的 分析贵州省人类免疫缺陷病毒1型(HIV-1)毒株亚型的变异特征,为获得性免疫缺陷综合征(艾滋病,AIDS)防治提供科学依据.方法 收集贵州省1998、2002、2007年HIV-1感染者190例,采集血液样品,采用巢式聚合酶链反应(nested PCR)扩增env基因并进行测序分析,与国际标准亚型毒株和其他地区阳性株进行对比,根据[同源性、离散率等]分析HIV-1毒株亚型的变异特征.结果 贵州省HIV-Ⅰ毒株经变异产生3种新亚型毒株,B、B′、C亚型通过基因重组变异为CRF 07-BC、CRF08 -BC流行性重组亚型毒株;E亚型毒株变异成了CRF01-AE重组亚型毒株;3种亚型毒株分别占当年核酸检测阳性数的63.41％、36.59％、52.10％;CRF07-BC、CRF08-BC与来源于印度的C.IN.92.同源,CRF01-AE与从欧美传入泰国的01 AE.TH90.同源;变异后的BC亚型组内基因离散率为(0.049±0.007)％,AE亚型的组内基因离散率为(0.064±0.008)％.结论 贵州省的HIV-1毒株具有高度变异特性;HIV-Ⅰ变异毒株在传播和流行中较易形成当地流行的优势毒株.     

Introduction of HIV-2 and multiple HIV-1 subtypes to Lebanon.

HIV genetic variability, phylogenetic relationships, and transmission dynamics were analyzed in 26 HIV-infected patients from Lebanon. Twenty-five specimens were identified as HIV-1 and one as HIV-2 subtype B. The 25 strains were classified into six env-C2-V3 HIV-1 subtypes: B (n = 10), A (n = 11), C (n = 1), D (n = 1), G (n = 1), and unclassifiable. Potential recombinants combining parts of viral regions from different subtypes Aenv/Dpol/Agag, Genv/Apol, and the unclassifiable-subtype(env)/unclassifiable-subtype(pol)/Agag were found in three patients. Epidemiologic analysis of travel histories and behavioral risks indicated that HIV-1 and HIV-2 subtypes reflected HIV strains prevalent in countries visited by patients or their sex partners. Spread of complex HIV-subtype distribution patterns to regions where HIV is not endemic may be more common than previously thought. Blood screening for both HIV-1 and HIV-2 in Lebanon is recommended to protect the blood supply. HIV subtype data provide information for vaccine development.     

辽宁省2008-2010年HIV-1基因亚型分布特征及流行病学分析

HIV-1毒株的感染力较强,是目前HIV流行的主要病毒株和重点研究对象[1].HW-1分为M(main)、O(outlier)和N(non-M-non-O)3个组.其中M组又分为A～K亚型.近年又证实了至少16种各种亚型的重组型CRF 01至CRF016.本研究对59例HIV-1感染者血浆样本进行基因扩增和序列分析并收集相关流行病学资料,结果报道如下. 1.材料与方法: (1)样本来源:选取2008-2011年经病毒载量检测,载量＞1000 copy/ml的59例样本进行HIV蛋白酶(PR)和反转录酶(RT)基因区的扩增和测序.     

广西壮族自治区2008 - 2009年HIV-1流行毒株基因型及其分布

目的了解广西地区目前HIV-1流行毒株的基因型及其分布。方法收集广西地区13个市294名2008-2009年新诊断的HIV感染者血浆标本和背景信息,感染途径主要为异性性传播(86.1%)。采用RT PCR法分别扩增HIV-1 gag,pol全长基因(分别为1584 by和3147 by)及enu:基因的C2V3片段(558 bp),序列编辑后用Genotyping及Mega 5.031具确定病毒的基因型,用Simplot和Recombinant HIV-1 Drawing Tool软件进行病毒基因的重组分析。结果获得全长gag基因序列270条、全长pol基因序列246条、。enu>基因C2V3区序列223条,确定272例标本的基因型。CRFO1_AE占的比例最高(77.6% ),其次为CRF08_BC(10.7%)和CRF07_BC ( 7.4% ),有4例B(B'')亚型,1例G亚型,还有7例未知重组型。性别、民族间病毒基因型分布的差异无统计学意义。7株新型重组毒株有6株以CRF01_AE为母株,嵌人B和/(或)C的片段,还有1株为CRF07_BC和CRF08_BC的二代重组。结论广西地区目前流行的HIV-1毒株以CRFO1_AE为主,并出现以CRFO1_AE为母株嵌人其他毒株基因片段的新型重组毒株,呈现基因组结构复杂化趋势。     

HIV-1 subtypes and recombinants in the Republic of Congo.

To document the actual genetic diversity of HIV-1 strains in the Republic of Congo, 114 HIV-1 positives persons were sampled in 2003 and 2004 after their informed consent. They were attending the teaching hospital, the reference health center in Makelekele, Brazzaville and the regional hospital centers in Pointe-Noire, Gamboma and Ouesso. A total of 104 samples were genetically characterized by direct sequencing of the p24 gag region and 80 were also subtyped in the V3-V5 env region. The genetic subtype distribution of the Congolese strains showed the predominance of subtype A (36.5% and 32.5% in gag and env, respectively) and G (30.8% and 21.25%), whereas subtype D strains represented 12.5% and 15%. Subtypes C, F, H, J, K and the CRFs-01, -02, -05 -06, and also the recently characterized CRF18 were seen at lower rates. Finally, 4.8% (gag) and 6.25% (env) of the strains could not be classified. Moreover, a high intra-subtype diversity was observed in our study. Among 70 strains which have been characterized in the two genomic regions, 14 (20%) appeared to be unique recombinants. These data show a high genetic variability in the Republic of Congo, where all the subtypes have been documented together with certain subsubtypes and several CRFs.     

云南省德宏州2011年HIV-1不同亚型人群分布特征分析

目的 研究云南省德宏州HIV-1亚型的流行特点。方法 收集2011年1-5月德宏州HIV-l抗体确认阳性血浆样品300份,提取RNA后用巢式PCR对gag基因和env基因的部分片段进行扩增。扩增产物经基因序列测定,所得序列通过构建系统进化树确定HIV-1的分子亚型。结果 结合2个基因片段,共有222份样品获得分型结果,主要为C亚型(43.2%, 96/222),其他依次为独特重组形式(URF; 27.O%, 60/222)、CRF01_AE(21.2%, 47/222)、CRF08_BC(5.0%, 11/222)、B’(2.3%, 5/222)和CRF07_BC(1.4%, 3/222)。C亚型是性传播人群和注射吸毒人群中的首要亚型,但不同传播途径人群中亚型分布具有不同的模式。异性传播人群包括该地区检测到6种基因型,主要为C亚型(40.7%,70/172)、CRFOI_AE(25.O%, 43/172)和多种URF(25.0%, 43/172),呈现亚型分布的多样化。注射吸毒人群中包括除B''和CRF07_BC以外的3种亚型及多种URF,主要为C亚型(54.8%, 23/42 J和URF(38.1%, 16/42),呈现亚型相对集中的趋势。URF比例的显著上升成为该地区的另一个流行特点,包括BC重组(41.7%, 25/60)和与CRF01 _AE相关的重组(58.3%, 35/60),这两种URF在性传播和注射吸毒人群中分布的差异无统计学意义。结论 德宏州HIV-1流行株较为复杂,存在5种亚型和多种URF．其中C亚型为主要流行株,不同传播途径亚型分布模式存在差异．     

不同亚型的人类免疫缺陷病毒Ⅰ型毒株混合感染分析

目的：了解我国人类免疫缺陷病毒（HIV）感染中是否存在不同HIV－1亚型混合感染,分析其传染来源,方法：应用巢式－PCR方法对3例HIV－1感染外周血单个核细胞的HIV－1膜蛋白基因进行扩增。并对C2－V3及其邻区360个核苷酸序列进行测定和分析,计算基因离散率和系统进行化树。结果：3例感染体内有B和C或B′和E2种不同HIV－1亚型毒株序列,各亚型毒株与相应的Bcon、Ccon、Econ国际亚型毒株序列间的基因离散率分别为5．07％－7．26％、3．23％、5．38％－5．99％;同一个体内不同亚型毒株序列间的基因离散率分别为23．52％、20．69％、28．44％;根据gp120V3环顶端四肽序列特征,发现有卖淫和静脉吸毒史妓女体内的sz46-1具有典型的欧美B亚型GPGR序列,sz8-2为GPGH,其他毒株均为泰国B（B′）和E亚型所特有的CPGQ序列;进一步系统树分析显示,sz12、sz46-1与Bcon丛集一起,sz1-1和sz8-2,sz46-2分别与Econ、Ccon丛集。结论同一个体可以同时感染不同亚型HIV－1毒株,多种高危行为可能是导致混合感染的主要原因。     

Demographic history of HIV-1 subtypes B and F in Brazil.

The reconstruction of the epidemic history of several HIV populations, by using methods that infer the population history from sampled gene sequence data, has revealed important subtype-specific and regional-specific differences in patterns of epidemic growth. Here, we employ Bayesian coalescent-based methods to compare the population history of the HIV-1 subtype B and F1 epidemics in Brazil from non-contemporary env and pol gene sequences. Our results suggest that after the introduction of the subtypes B and F1 into Brazilian population, around mid to late 1960s and late 1970s, respectively, these subtypes experienced an initial period of exponential growth with similar epidemic growth rates ( approximately 0.5-0.6year(-1)). Later, the spreading rate of both subtypes seems to have slowed-down since mid to late 1980s. This demographic pattern is very similar to that reported for the subtype B epidemics in high-income countries where HIV was initially transmitted through homosexual intercourse and injecting drug use, as in Brazil; suggesting that the characteristics of transmission networks may be a key determinant of the HIV epidemic growth pattern. It is important to note that most of the subtype B and F1 sequences used in this study come from the Southeast region that has been the most affected by the AIDS epidemic in Brazil, being responsible for around 63% of all AIDS cases reported since the early eighties; but may not represent the demographic trend of the HIV-1 epidemic in other Brazilian regions.     

受血及献血者HIV-1外膜蛋白ENV基因序列分析

目的　了解在广东省受血及献血者中发现的HIV 1亚型的流行规律及其与国际参考株的同源性。方法　应用套式聚合酶链反应 (PCR)对 1 4例采自于广东省HIV 1抗体阳性的受血者或献血者淋巴细胞富集液的核酸样品进行扩增 ,并使用ABI377型测序仪对扩增产物测序后 ,对其ENV基因C2 V3段的核酸序列进行比较分析。结果　 1 4份血样中 ,7份为泰国B’亚型 ,与国际参考株RL4 2的距离最近 ,基因离散率为 (6 0 82± 2 6 0 7) % ,组内离散率为 (5 96 3± 2 383) % ;4份为AE重组亚型 ,与国际参考株TH 90 CM2 4 0最近 ,基因离散率为 (8 90 0± 1 830 ) % ,组内离散率为 (1 3 81 0± 1 31 7) % ;2份为 0 7 BC重组亚型 ,与国际参考株CN 97 C5 4A最近 ,基因离散率为 (4 1 5 5± 1 2 2 3) % ,组内基因距离为 6 36 % ;1份为 0 8 BC重组亚型 ,与国际参考株 97CNGX 9F最近 ,基因距离为 0 97%。结论　本次检测的广东省受血及献血者HIV 1以泰国B’亚型为主 ,也存在主要在性途径感染人群中流行的AE重组亚型和吸毒者中流行的 0 7 BC、0 8 BC重组亚型。     

PEIA法检测吸毒人群HIV-1血清亚型分析

目的建立PEIA法检测HIV-1血清亚型,了解吸毒人群HIV-1感染毒株的血清亚型分布特征,为疫苗和诊断试剂的研制、使用提供科学依据。方法问卷调查了解一般情况和HIV-1感染行为;ELISA法检测HIV-1的抗体阳性率,,nested-PCR检测HIV-1 evn基因V3区;PEIA法检测HIV-1血清亚型。结果吸毒人群HIV-1感染率为57.14%,感染因素为静脉共用注射器吸毒和无保护性交。HIV-1毒株血清亚型为C、E、EC混合型,以C亚型为优势亚型,同一个体可能同时感染不同亚型的病毒株或出现重组毒株。除了上述亚型外,还存在其他未能检测出来的亚型。结论PEIA法检测HIV-1血清亚型具有快速、简便的特点。吸毒人群HIV-1毒株亚型表现为多样性,应加强其变异的监测和研究。