Changes in pneumococcal serotypes distribution and penicillin resistance in healthy children five years after generalization of PCV10.

Objective: Streptococcus pneumoniae (S. pneumoniae) nasopharyngeal carriage has significantly decreased after the generalization of pneumococcal vaccination worldwide. This study sought to investigate changes in S. pneumoniae carriage rates, serotype distribution and penicillin non-susceptibility following the generalization of 10-valent pneumococcal conjugate vaccine. Methods: A prospective study was conducted in Marrakesh, Morocco, between 2017 and 2018, among healthy children attending vaccination centers. We collected nasopharyngeal swabs and questionnaire data for each child. Using univariate logistic regression, we analyzed the association between S. pneumoniae carriage and various risk factors. Comparisons of serotype diversity and penicillin resistance between 2017 and 2018 and the period before introduction of vaccination (2008-2009, n = 660) were performed using Simpson index and the chi-squared test, respectively. Results: During 2017-2018, 515 children aged between 6 and 36 months participated. The S. pneumoniae carriage rate was 43.3%. Looking at the distribution serotypes, the rate of PCV10 serotypes rate was only 9.6%. Among non-vaccine serotypes, an increase in serotypes 6C/6D (22; 14%), 19B/19C (17; 10.8%), and 15B/15C (11; 7%) was observed. A particular increase in serotype diversity was also observed after the generalization of PCV10 (p < 0.001). S. pneumoniae non-susceptible to penicillin decreased, reaching a rate of 26.6% in 2017-2018. Conclusion: The significant change in S. pneumoniae carriage, serotype distribution, and penicillin resistance highlights the effectiveness of the pneumococcal conjugate vaccine among children in Marrakesh, Morocco.

Isolated Sudden Bilateral Neurosensory Hearing Loss as a Presentation of Lyme Neuroborreliosis: A Case Study.

Lyme neuroborreliosis (LNB) is a rare but potentially serious manifestation of Lyme disease, caused by the spirochete Borrelia burgdorferi. Although LNB can affect various neurological systems, neurosensory hearing loss as the sole presentation is uncommon. We report a case of a 23-year-old woman who presented with a 2-month history of temporal headache, tinnitus, and instability, which was followed by sudden bilateral hearing loss without any other associated symptoms. Pure-tone audiometry revealed profound bilateral hearing loss. Serological testing for various pathogens was negative, except for B. burgdorferi IgM, which was confirmed using Western blot analysis. The patient received doxycycline treatment; unfortunately, no recovery of hearing was observed. This case report highlights the importance of considering LNB as a potential cause of neurosensory hearing loss, particularly in areas where Lyme disease is endemic, as well as the need for timely diagnosis and treatment to prevent potential complications.

Rabies in Morocco: Epidemiological Aspects and Post-exposure Prophylaxis Management.

Background Rabies is a zoonosis transmitted accidentally to humans and is fatal once clinical signs appear. In Morocco, rabies remains a difficult disease to eradicate, with dogs being the main source of contamination. Transmission of this illness can be avoided by promptly implementing post-exposure prophylaxis (PEP) following animal exposure. Inappropriate or delayed PEP increases the risk of acute infection. This study aims to describe and analyze the characteristics of exposure, investigate the factors related to delay in initiating PEP, and evaluate the attitudes and practices of patients towards animal exposure in the region of Ouarzazate between 2016 and 2019. Methods This was a retrospective study with statistical analysis. The data on animal exposure was collected from the Anti-Rabies Center (ARC) located in Ouarzazate Province, Morocco. Results A predominance of male cases (61.3%) among victims of animal exposure was found. The age group of five to 14 years was the most affected (23.5%). The upper limb represented the most frequent site of exposure (49.4%). Around 52.1% of patients presented with multiple lesions. About 54.4% of cases were bitten by a stray animal. Dogs were responsible for 47.8% of the bites. All exposed individuals performed wound cleansing prior to arrival at the ARC. Post-exposure prophylaxis was initiated in 34.5% of cases between 24 to 48 hours, while 26.1% of cases delayed it beyond 48 hours. Around 34% of patients did not complete their vaccination schedule. Regarding the factors associated with the delay in PEP, we found significant associations with patient age, place of residence (urban or rural), distance from the ARC (>30 km or <30 km), nature, number, and injury status (p≤0.05). Significant associations (p≤0.05) were also found with dog bites and their type (domestic or stray). Conclusion Our findings indicate that better awareness about rabies and PEP management is needed, especially among the rural population.

Antibiotic Resistance of Streptococcus pneumoniae in the Nasopharynx of Healthy Children Less than Five Years Old after the Generalization of Pneumococcal Vaccination in Marrakesh, Morocco.

Streptococcus pneumoniae (S. pneumoniae) remains one of the most important pathogens causing childhood infections. The spread of antibiotic-resistant bacteria is a leading cause of treatment failure in children. The purpose of this investigation is to report the antibiotic and multidrug resistance (MDR) of S. pneumoniae strains isolated from healthy children throughout the years 2020-2022. Antimicrobial susceptibility testing of S. pneumoniae strains in selected antimicrobials was performed using disk diffusion and E-test methods on bloodMueller-Hinton agar. The antimicrobials tested included oxacillin, amoxicillin, ceftriaxone, norfloxacin, gentamicin, vancomycin, erythromycin, clindamycin, pristinamycin, tetracycline, chloramphenicol, and trimethoprim-sulfamethoxazole. A total of 201 S. pneumoniae strains were isolated from the nasopharynx of healthy children in Marrakesh, Morocco. The highest rate of resistance of S. pneumoniae was found in penicillin (57.2%), followed by tetracycline (20.9%), and erythromycin (17.9%). The rates of resistance to clindamycin, trimethoprim-sulfamethoxazole, and chloramphenicol were 14.9%, 4%, and 1.5%, respectively. All isolates were susceptible to norfloxacin, gentamicin, vancomycin, and pristinamycin. Approximately 17% of all S. pneumoniae strains were resistant to at least three different antibiotic families. This study showed a low rate of antibiotics resistance among nasopharyngeal S. pneumoniae strains, and it is thus essential to monitor S. pneumoniae susceptibility in healthy children.

Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae among children with acute otitis media in Marrakech, Morocco.

Background and Objectives: Streptococcus pneumonia (S. pneumoniae) is one of the most frequent pathogens leading to a variety of clinical manifestations. The effects of S. pneumoniae carriage on acute otitis media (AOM) are poorly studied. The study aimed to assess the serotype's distribution and antimicrobial susceptibility in children with AOM after the implementation of the pneumococcal conjugate vaccine (PCV) in Morocco. Materials and Methods: We conducted a prospective study of AOM children aged 6 to 36 months who visited pediatric centers in Marrakesh between January to June 2018. Parents were asked to complete a questionnaire and a swab was collected from each child. The S. pneumoniae strains were further identified (Hemolysis, optochin sensitivity, and agglutination test), serogrouped (IMMULEX PNEUMOTEST agglutination test), serotyped (Real time PCR) and tested for antimicrobial susceptibility. Results: The S. pneumoniae carriage rate was 49.7% (87/175). As estimated, non-vaccine serotypes (NVT) were most prevalent (51/63; 81%). The most frequent serotypes were 6C/6D (12.7%), 10 (9.5%), and 19B/19C (9.5%). The S. pneumoniae strains that were isolated showed a diminished susceptibility to penicillin G with a rate of 27.5%. Penicillin non-susceptible pneumococci (PNSP) was mostly associated with NVT. More than 90% of S. pneumoniae isolates were susceptible to chloramphenicol (97.5%), clindamycin (97.5%), erythromycin (97.5%), levofloxacin (97.5%), pristinamycin (97.5%), gentamicin (92.5%), and teicoplanin (92.5%). Conclusion: Important nasopharyngeal carriage prevalence was reported among children with AOM. The study showed that new NVT are emerging, including 6C/6D and 10. Furthermore, susceptibility was significantly higher against all antibiotics tested except for penicillin G and amoxicillin.

Implementation of a prospective study for enhancing surveillance of invasive bacterial infections in North Africa.

OBJECTIVES: We implemented a project named MENINGSTOP in three countries of North Africa (Algeria, Morocco and Tunisia). The main objective was to use real-time PCR to detect, identify and type the three main agents (Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae) responsible for invasive bacterial infections (IBI). METHODS: The protocol of WHO and US CDC for real-time PCR was used to detect and type the three bacterial agents in clinical samples. We also designated two quality exercises using an external interlaboratory study and cross-testing of 10% of randomly selected samples. RESULTS: Among the 752 samples tested, 18% were positive for one of the three agents. N. meningitidis was the most frequent globally reaching 9% of all samples (7% to 17% range) followed by S. pneumoniae 8% of all samples (6% to 15%). Group B meningococci was the most frequent (74% of all positive samples for meningococci and ranging from 50% to 90%). Quality assurance showed >85% correlation scores. CONCLUSIONS: Real-time PCR can help improving epidemiological surveillance. Data confirm the prevalence of meningococci B. Our project adds a reliable tool to enhance surveillance and to help decision making in vaccination strategies against IBI.

Rift Valley Fever and West Nile virus vectors in Morocco: Current situation and future anticipated scenarios.

Rift Valley Fever (RVF) and West Nile virus (WNV) are two important emerging Arboviruses transmitted by Aedes and Culex mosquitoes, typically Ae. caspius, Ae. detritus and Cx. pipiens in temperate regions. In Morocco, several outbreaks of WNV (1996, 2003 and 2010), affecting horses mostly, have been reported in north-western regions resulting in the death of 55 horses and one person cumulatively. Serological evidence of WNV local circulation, performed one year after the latest outbreak, revealed WNV neutralizing bodies in 59 out of 499 tested participants (El Rhaffouli et al., 2012). The country also shares common borders with northern Mauritania, where RVF is often documented. Human movement, livestock trade, climate changes and the availability of susceptible mosquito vectors are expected to increase the spread of these diseases in the country. Thus, in this study, we gathered a data set summarizing occurrences of Ae. caspius, Ae. detritus and Cx. pipiens in the country, and generated model prediction for their potential distribution under both current and future (2050) climate conditions, as a proxy to identify regions at-risk of RVF and WNV probable expansion. We found that the north-western regions (where the population is most concentrated), specifically along the Atlantic coastline, are highly suitable for Ae. caspius, Ae. detritus and Cx. pipiens, under present-day conditions. Future model scenarios anticipated possible range changes for the three mosquitoes under all climatic assumptions. All of the studied species are prospected to gain new areas that are currently not suitable, even under the most optimist scenario, thus placing additional human populations at risk. Our maps and predictions offer an opportunity to strategically target surveillance and control programmes. Public health officials, entomological surveillance and control delegation must augment efforts and continuously monitor these areas to reduce and minimize human infection risk.

Global potential distribution of three underappreciated arboviruses vectors (Aedes japonicus, Aedes vexans and Aedes vittatus) under current and future climate conditions.

Arboviruses (arthropod-borne viruses) are expanding their geographic range, posing significant health threats to millions of people worldwide. This expansion is associated with efficient and suitable vector availability. Apart from the well-known Aedes aegypti and Ae. albopictus, other Aedes species may potentially promote the geographic spread of arboviruses because these viruses have similar vector requirements. Aedes japonicus, Ae. vexans and Ae. vittatus are a growing concern, given their potential and known vector competence for several arboviruses including dengue, chikungunya, and Zika viruses. In the present study, we developed detailed maps of their global potential distributions under both current and future (2050) climate conditions, using an ecological niche modeling approach (Maxent). Under present-day conditions, Ae. japonicus and Ae. vexans have suitable areas in the northeastern United States, across Europe and in southeastern China, whereas the tropical regions of South America, Africa and Asia are more suitable for Ae. vittatus. Future scenarios anticipated range changes for the three species, with each expected to expand into new areas that are currently not suitable. By 2050, Ae. japonicus will have a broader potential distribution across much of Europe, the United States, western Russia and central Asia. Aedes vexans may be able to expand its range, especially in Libya, Egypt and southern Australia. For Ae. vittatus, future projections indicated areas at risk in sub-Saharan Africa and the Middle East. As such, these species deserve as much attention as Ae. aegypti and Ae. albopictus when processing arboviruses risk assessments and our findings may help to better understand the potential distribution of each species.

Bilateral tuberculous psoas abscess.

The unilateral psoas abscess is a rare disease that is often caused by common germs, including Staphylococcus aureus . Tuberculous origin and bilateral involvement are even rarer, especially in developed countries. It may be primary or secondary to a neighbourhood focus. We report a case of bilateral tuberculous abscess of psoas in an immunocompetent patient secondary to spondylodiscitis.

Seroprevalence of rubella in pregnant women in Southern Morocco.

Rubella is a generally benign but dangerous viral infection in early pregnancy, due to the teratogenic potential of the virus. Indeed, it causes spontaneous abortions, in-utero fetal death, premature labor and congenital malformations known as congenital rubella syndrome. The purpose of this study is to determine the immune status of rubella in pregnant women in southern Morocco. A prospective, multicentre study was conducted in 2017 for the detection of rubella IgG and IgM antibodies in 380 pregnant women aged 17 to 46 years, using the Architect i1000 chemiluminescent microparticle immunoassay. Eigthy for percent (84.7%) of women were seropositive. Ten percent of multiparous women remained seronegative despite recommendations for vaccination after delivery. Preventive measures against congenital rubella need to be strengthened, and vaccination is needed in non-immunized women. Vaccination awareness campaigns, especially among non-immunized multiparous women, remain essential.

[Brain abscess caused by Streptococcus intermedius: a case report]. / Abcès cérébral à Streptococcus intermedius : à propos d'un cas.

Streptococcus intermedius is considered as a commensal of the oropharynx, but can be a source of serious infections. We report a case of cerebral abscess in a young man of 18 years, who was admitted to the emergency room for consciousness disorder, and whose cerebral CT showed a frontal mass evoking the diagnosis of abscess. Diagnosis was confirmed by bacteriological examination of puncture fluid which was in favor of Streptococcus intermedius abscess.

[Psoas abscess due to Candida tropicalis: a case report]. / Abcès de psoas à Candida tropicalis : à propos d'un cas.

Psoas abscess is a rare infection, difficult to diagnose, which can be primary or secondary, it is often caused by a bacterial micro-organism (Staphylococcus aureus, Escherichia coli), and in rare cases by a fungal micro-organism (Candida). We report an exceptional case of Candida tropicalis psoas abscess in a 52-year-old man with no history of pathology who had inflammatory lower back pain with fever and general deterioration. The biological assessment showed a renal insufficiency and a biological inflammatory syndrome, a computed tomography made in urgency was in favor of a psoas abscess. The bacteriological study of percutaneous drainage product allowed to isolate Candida tropicalis.

Group o human immunodeficiency virus type 1 infection that escaped detection in two immmunoassays.

We report a case of human immunodeficiency virus type 1 group O infection not detected by two highly sensitive immunoassays. The sera were strongly reactive to the V3 peptide of group O but not to the gp41 immunodominant epitope. Gp41 was sequenced, confirming that this virus belonged to group O.