Characterization of Staphylococcus aureus from Pasteur Institute in Côte d'Ivoire: Methicillin Resistance, Reduced Sensitivity to Vancomycin, Panton-Valentine Leucotoxin and Exfoliatins.

Staphylococcus aureus, which causes various infections, particularly suppurations, expresses many virulence factors. The resistance of S. aureus to methicillin (MRSA) which can spread to vancomycin constitutes a major challenge in infectiology. The search for virulence and resistance factors is therefore of interest to better understand the mechanisms of this pathogenicity. The objectives of this study were to determine the frequency of phenotypic and genotypic (mecA, vanB) resistances, the frequency of virulence genes (eta, etb, and lukS) and to investigate the resistant strains for the presence of virulence genes. On thirty-one strains isolated from infections at the Pasteur Institute of Côte d'Ivoire, the study of susceptibility to methicillin and vancomycin was carried out by phenotypic and molecular methods. We observed phenotypic and genotypic resistance to methicillin of 41.9% and 32.3% respectively. Despite a suspicion of very high vancomycin susceptibility reduced, 25.8% by phenotypic method, the vanB gene was only found in 3.2% of strains. The prevalence of virulence genes was high with the eta gene, 96.8%, and the lukS gene 45.2%. The mecA gene was present with an eta gene in 32.3% of strains and in 9.7% with the lukS gene, however the vanB gene was not present in any strain carrying virulence factors. These results should lead to the screening of other van genes for resistance to vancomycin.

[Evaluation of first void urine in the detection of Neisseria gonorrhoeae in patients less symptomatic in Abidjan (Côte d'Ivoire)]. / Evaluation du premier jet d'urine dans la détection de Neisseria gonorrhoeae chez des patients paucisymptomatiques à Abdidjan (Côte d'Ivoire).

Various diagnostic methods have been described to detect Neisseria gonorrhoeae. Collection of first void urine is advantageous because it is non-invasive, reproducible, and painless; and provides specimens that have already been used for detection of N. gonorrhoeae by molecular tools. The purpose of this study was to assess the usefulness of first void urine for detection of N. gonorrhoeae using conventional bacteriologic techniques in patients with low-grade symptoms. Investigation was focused on first void urine and urethral secretion specimens collected from 87 male patients who were undergoing diagnotic workup for suspicion of sexually transmitted infection. Direct microscopic examination of smears stained using the Gram technique and cultures on modified Thayer-Martin medium and on cooked blood agar were performed on each specimen. The prevalence of urethritis was 58.0%. Gonorrhoea was diagnosed in 7.5% of cases. The sensitivity and specificity of microscopic examination of first void urine for detection of Gram-negative diplococci were 85.7% and 97.5% respectively. First void urine was less productive than urethral secretion for detection of urethritis: sensitivity, 44.4% and specificity, 100%, and urethral flora: sensitivity, 59% and specificity of 96.9%. The good performance of first void urine specimens for detection of Gram-negative diplococci by microscopy may justify their use for identification of N. gonorrhoeae in level 1 laboratories. First void urine could also be useful for epidemiological studies and large-scale screening surveys.

[Agents of community acquired purulent meningitis in the child: epidemiologic trends in Abidjan, Côte d'Ivoire, from the year 1995 to 2000]. / Agents des méningites purulentes communautaires de l'enfant: tendance épidémiologique à Abidjan, Côte d'Ivoire, de 1995 à l'an 2000.

OBJECTIVE: To assess prevalence and trends of community acquired bacterial meningitis in childhood in a tertiary-care hospital before introduction of the HIB conjugate vaccine. STUDY DESIGN: Laboratory based data were recorded from January 1995 to December 2000 on two hundred and eighty seven children with bacterial meningitis. Identification of bacterial agents was performed with conventional methods. Information including age, gender, bacterial aetiology of meningitis, month and annual prevalence of agents was examined. RESULTS: The age of infected children ranges from 1 to 10 years with an average and median age of 34.2 months and 12 months respectively. Fifty five percent of children were male. The overall prevalence of agents were respectively 47.8% for Streptococcus pneumoniae followed by Haemophilus influenzae 39% and Neisseria meningitidis 13.2% with predominance of serogroup C. Stratification by age group shows that Haemophilus influenzae was the most common agent among children < 1 year of age following by S. pneumoniae and N. meningitidis. After 5 years, the number of cases of S. pneumoniae and N. meningitidis was prevalent. After 10 years, N. meningitidis was the first aetiology of bacterial meningitis. The six years data recorded highlighted the high and stable prevalence of H. influenzae B and S. pneumoniae and the low prevalence of N. meningitidis and high incidence of invasive meningococcal, pneumococcal and Haemophilus influenzae during the six years between September and February. CONCLUSION: Conjugated HIB vaccine is needed in our country to lower incidence of H. influenzae meningitis as already seen in developed countries. Continuous surveillance is necessary to monitor the disease trends, serotype distribution and antimicrobial susceptibility in order to implement appropriate public health interventions against community acquired bacterial meningitis.

[Contribution of gene amplification in Mycobacterium ulcerans detection in exudates and cutaneous biopsies in Côte d'Ivoire]. / Apport de l'amplification génique dans la détection de Mycobacterium ulcerans dans les exsudats et les biopsies cutanées en Côte d'Ivoire.

Mycobacterium ulcerans skin ulceration is a major issue of public health in Côte d'Ivoire. The diagnosis of M. ulcerans infection is hampered by the slow growth of the bacterium in culture, implying a delay of several weeks before a specific diagnosis can be obtained. In Côte d'Ivoire the diagnosis of Buruli ulcer is almost based on clinical features. During the last decade, many studies have demonstrated the extremely high capacity of PCR for rapidly and specifically detecting bacteria and genes of interest. That ability has revealed PCR as a powerful tool in clinical microbiology studies. In this study we evaluated the M. ulcerans detection in specimens of exudates and biopsies collected from patients clinically suspected of Buruli ulcer and treated in "Raoul Follereau" centre of Manikro in the North-central region of Côte d'Ivoire. The microscopic research of BAAR in 185 swabs loaded with skin lesions collected from these patients showed a positive rate of 14.6%. The PCR detection in 48 h or 72 h of the M. ulcerans IS2404 and IS2606 in the swabs and in the 26 biopsies, from these patients, showed positive rates of 15.7% and 84.6% respectively and in the same samples. These results obtained with PCR detection of M. ulcerans insertions sequences suggest that this technique performed with exudates and biopsy can be used to confirm a routine specific diagnosis of M. ulcerans and early screening of Buruli ulcer in Côte d'Ivoire.

[Seroprevalence of rubella in 461 pregnant women in Abidjan (Cote d'Ivoire)]. / Séroprévalence de la rubéole chez 461 femmes enceintes a Abidjan (Côte-d'Ivoire).

The authors report the results of a seroepidemiological study of rubella in pregnancy. Rubella antibodies were present in 82% of the pregnant women and 18% were seronegative. Most of seronegative women were less than twenty years old, nulliparous, on first period of gestation and in low socioeconomical conditions.

[Prevalence of 4 agents of sexually transmitted diseases in leukorrhea in Abidjan (Ivory Coast)]. / Prévalence de quatre agents des maladies transmises sexuellement au cours des leucorrhées à Abidjan (Côte-D'Ivoire).

6,603 women with vaginal discharges were investigated for genital infection with four sexually transmitted diseases. Germs of vaginitis were isolated with prevalence as following: C. albicans 25%, G. vaginalis 17.4%, T. vaginalis 8.2%. Cervicitis with N. gonorrhoeae represented 3.2% of cases.

[Evolution of Streptococcus pneumoniae antibiotic resistance in Abidjan: update on nasopharyngeal carriage, from 1997 to 2001]. / Evolution de la résistance de Streptococcus pneumoniae aux antibiotiques à Abidjan: enquêtes de portage nasopharyngé de 1997 à 2001.

UNLABELLED: The emerging antibiotic resistance and worldwide diffusion of Streptococcus pneumoniae strains is an important public health problem. OBJECTIVES: The aims of this study were to study the evolution of S. pneumoniae resistance rates to penicillin G and other antimicrobials from nasopharyngeal carriage. METHOD: Four hundred and eighty-two nasopharyngeal samples of S. pneumoniae were studied from 1997 to 2001. The Kirby-Bauer technique was used to screen the susceptibility of samples and completed with the determination of penicillin G minimal inhibitory concentration using the E-test. RESULTS: Resistance to penicillin increased from 1997 to 2001: 8.5% in 1997, 20.7% in 1998, 16% in 1999, and 23.5% in 2001. However, the resistance to other beta-lactam antibiotics was low. The rate of resistance to cotrimoxazole increased from 52.2% in 1997 to 84.3% in 2001, with a higher degree of resistance in 2001. The resistance of S. pneumoniae to tetracycline increased. In contrast, the prevalence of erythromycin-resistant pneumococcal samples decreased from 11.6% in 1997 to 8% in 2001. The resistance to three or more antibiotics (multi-drug resistant) was also increased from 9.4% in 1997 to 23.5% in 2001. CONCLUSION: This data shows that carriage of antibiotic-resistant pneumococci is increasing in Abidjan. It will be interesting to assess the current bacterial resistance patterns by a national epidemiological observatory.

Evaluation of 17 medicinal plants from Northern Côte d'Ivoire for their in vitro activity against Streptococcus pneumoniae.

Twenty crude extracts from 17 species out of 11 families were assessed for their antibacterial activity against Streptococcus pneumoniae (Pneumococcus). The selected plants are used in Northern Côte d'Ivoire to treat various infections including respiratory track diseases. From all the tested extracts, only 7 from 6 plants showed a promising in vitro bactericidal activity against Pneumococcus, including strains resistant to penicillin. The most active extracts were from Erythrina senegalensis (Fabaceae), Piliostigma thonningii (Caesalpiniaceae), Waltheria indica (Sterculiaceae), Andira inermis (Fabaceae), Uapaca togoensis (Euphorbiaceae), Keetia hispida (Rubiaceae) and Combretum molle (Combretaceae). This is the first time that the antipneumococcal activity of the tested plants is reported. The results of this preliminary investigation support the traditional use of these plants in the treatment of pneumococcal infections. The most active of them could be candidates for isolation of compounds which could serve as lead structures for the development of new drugs against Streptococcus pneumoniae.

Antimicrobial resistance of nasopharyngeal isolates of Streptococcus pneumoniae in healthy carriers: report of a study in 5-year-olds in Marcory, Abidjan, Côte d'Ivoire.

The increasing prevalence of antibiotic-resistant Streptococcus pneumoniae is of growing public health concern. The aim of this study was to assess resistance rates of S. pneumoniae to penicillin and other antimicrobial agents. Between November 1997 and February 1998 in a community health centre in Marcory, an Abidjan suburb, 138 S. pneumoniae strains were isolated from the nasopharynxes of 218 apparently healthy children aged 3-60 months. The sensitivity of the isolates was tested using the Kirby-Bauer method. In isolates with a possibly abnormal sensitivity to the Kirby-Bauer test, minimum inhibitory concentrations (MIC) were estimated using the E-test. Antimicrobials tested included penicillin G, amoxycillin, cefotaxime, cotrimoxazole, tetracycline, chloramphenicol, erythromycin, rifampicin and vancomycin. Twelve of 108 isolates (8.7%) had reduced sensitivity to penicillin G, and in three of them the MIC for penicillin reached at least 2 micrograms/ml. Resistance to amoxycillin and cefotaxime was lower than to penicillin (2.2%). With regard to cotrimoxazole, 37% were moderately resistant and 15.2% highly resistant. The lowest resistance rate observed was to rifampicin (2.2%) and the highest was to tetracycline (57.2%). Rates of resistance to erythromycin and chloramphenicol were 11.6% and 2.9%. All strains were sensitive to vancomycin. Multidrug resistance (MDR) was detected in 9.4% of S. pneumoniae isolates. In children, epidemiological surveillance of resistance can be monitored by bacteriological surveys, as shown in this study.