Etiology, antimicrobial susceptibility profiles, and mortality associated with bacterial meningitis among children in Egypt

PURPOSE: Surveillance for patients with meningitis is a high priority in order to determine the etiology of disease and design prevention strategies. This study presents data on the causes of bacterial meningitis among children <6 years of age treated in a network of hospitals throughout Egypt. METHODS: Training was provided to standardize the collection of clinical information and optimize recovery of bacterial pathogens. Bacterial isolates were tested for antimicrobial resistance patterns using Kirby Bauer disk diffusion, E-test and/or Beta-lactamase (BL) testing methods. RESULTS: Patients with culture-confirmed bacterial meningitis (228 children<6 years) were identified including 89 (39%) patients with H. influenzae (HI), 68 (30%) with Streptococcus pneumoniae (SP), 30 (13%) with N. meningitidis (NM), 18 (8%) with Mycobacterium tuberculosis (MTB) and 23 (10%) with other bacteria. The overall case fatality ratio was high (24%) and increased among children with TB meningitis (56%). The susceptibility for HI to ampicillin (AMP), chloramphenicol (C) and ceftriaxone (CRO) was 21%, 13%, and 100% respectively. The susceptibility for SP to C and CRO was 79% and 100%, respectively. CONCLUSIONS: HI and SP are the leading causes of bacterial meningitis among children in Egypt. The majority of HI strains tested were resistant to AMP or C suggesting the need for routine use of CRO as first line therapy. Among older children TB emerges as a significant cause of bacterial meningitis in Egypt.     

Anti-tumor necrosis factor-alpha therapy with infliximab as an alternative to corticosteroids in the treatment of human leukocyte antigen B27-associated acute anterior uveitis

OBJECTIVE: To evaluate the potentials of infliximab, a mouse-human chimeric immunoglobulin G1 monoclonal antibody that binds both the soluble form and the membrane-bound precursor of tumor necrosis factor-alpha (TNF-alpha), thus inhibiting a broad range of biologic activities of TNF-alpha, in the therapy of patients with acute HLA B27-associated anterior uveitis. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Seven consecutive patients with acute onset of HLA B27-associated anterior uveitis, with at least three anterior chamber cells. INTERVENTION: Infliximab IV (Centocor, Malvern, PA) at a dosage of 10 mg/kg body weight was used as the only anti-inflammatory drug. MAIN OUTCOME MEASURES: Anterior chamber cells and flare were evaluated before infliximab treatment and at defined time points after treatment. C-reactive protein (CRP) levels were assessed in all patients before IV delivery of infliximab and were re-evaluated after 1 week. RESULTS: Patients were observed for a mean period of 17 +/- 0.8 months. Seven patients received a single infliximab infusion of 10 mg/kg body weight. One patient received a second infusion 3 weeks after the first because of a uveitis flare-up. The median duration (+/- standard deviation) of uveitis was 8 +/- 12 days. All patients responded to infliximab with immediate improvement of clinical symptoms and a rapid decrease in anterior chamber cells. Total resolution of the uveitis was achieved with infliximab as the sole anti-inflammatory drug in all but one patient, who also showed systemic inflammatory activity, as indicated by a threefold increase in the serum CRP level. A relapse was seen in four patients after a median period of 5 +/- 6.4 months. CONCLUSION: Infliximab proved to be a powerful therapeutic agent in acute HLA B27-associated uveitis and may therefore be a future alternative or supplement to steroid treatment. Larger controlled studies on the efficacy and dosage of infliximab in different forms of anterior uveitis will nonetheless be needed to evaluate the effectiveness of anti-TNF-alpha treatment in acute, as well as chronic, uveitis.     

Laboratory-based surveillance of patients with bacterial meningitis in Egypt (1998–2004)

Laboratory-based surveillance for bacterial meningitis was conducted in a network of infectious disease hospitals in Egypt to better understand the epidemiology of this infection. Healthcare and laboratory personnel were trained in basic surveillance and microbiologic processing of cerebrospinal fluid (CSF) specimens. All bacterial isolates from CSF were confirmed and tested for antimicrobial susceptibility. PCR testing was performed on a random subset of purulent, culture-negative CSF specimens. Of 11,070 patients who met criteria for the case definition, 843 (8%) were culture positive (42% positive for Streptococcus pneumoniae, 20% for Haemophilus influenzae serotype b, 17% for each of Neisseria meningitidis and Mycobacterium tuberculosis, and 6% for other bacteria). Of 1,784 (46%) CSF specimens tested by PCR, 232 (13%) were positive for the first three major pathogens. Of N. meningitidis isolates, 52% belonged to serogroup A, 35% to serogroup B, and 4% to serogroup W135. S. pneumoniae isolates comprised 46 different serotypes, of which 6B, 1, 19A, 23F, and 6A were the most predominant. The overall case-fatality rate for culture-positive cases was 26% and was highest among patients with M. tuberculosis (47%). Factors significantly associated with death (p < 0.05) included admission to rural hospitals, long prodromal period, referral from other hospitals, antibiotic treatment prior to admission, and clear CSF (<100 cells/mm³). Susceptibility to ampicillin and ceftriaxone was observed in 44 and 100% of H. influenzae serotype b isolates and in 52 and 94% of S. pneumoniae isolates, respectively. This surveillance highlights the significant mortality and morbidity associated with bacterial meningitis in Egypt. Decision makers need to review current treatment guidelines and introduce appropriate vaccines for prevention and control of the disease.     

Development of Construction Material Using Wastewater: An Application of Circular Economy for Mass Production of Bricks

Water is one of the necessary ingredients for construction materials. Billions of gallons of clean water are wasted during the development of fired clay bricks. Similarly, the waste of clean water is a global issue. In this study, we develop fired clay bricks with the help of wastewater for the first time and compare these with clay bricks produced using groundwater, which is the conventional method. Both destructive (i.e., compressive strength (CS)) and non-destructive (i.e., ultrasonic pulse velocity (UPV)) tests are conducted on all fired clay brick specimens as per the American Society for Testing and Materials (ASTM). Physical (i.e., dimensions) and durability (water absorption, efflorescence, etc.) tests are also conducted. All kinds of brick satisfied the standard requirements of physical and durability characteristics. Similar or better strength of bricks were achieved using wastewater. The study concludes that the testing results of wastewater bricks were significantly 15–25% higher compared with groundwater-fired clay bricks. A large amount of wastewater can be used to develop bricks, and clean water can be saved to attain circular economy goals. Therefore, this study will help not only in developing low-cost bricks but also in saving clean water.