Prevalence of multi-drug resistant bacteria in intensive care units at Tripoli University Hospital, Tripoli, Libya.

Among hospitalized patients worldwide, infections caused by multidrug-resistant (MDR) bacteria are a major cause of morbidity and mortality. This study aimed to isolate MDR bacteria from five intensive care units (ICUs) at Tripoli University Hospital (TUH). A prospective cross-sectional study was conducted over a seven-month period (September 2022 to March 2023) across five ICUs at TUH. A total of 197 swabs were collected from Patients', healthcare workers' and ICUs equipment. Samples collected from patients were nasal swabs, oral cavity swabs, hand swabs, sputum specimens, skin swabs, umbilical venous catheter swabs, and around cannula. Swabs collected from health care workers were nasal swabs, whereas ICUs equipment's samples were from endotracheal tubes, oxygen masks, and neonatal incubators. Identification and antimicrobial susceptibility test was confirmed by using MicroScan auto SCAN 4 (Beckman Coulter). The most frequent strains were Gram negative bacilli 113 (57.4%) with the predominance of Acinetobacter baumannii 50/113 (44%) followed by Klebsiella pneumoniae 44/113 (40%) and Pseudomonas aeruginosa 6/113 (5.3%). The total Gram positive bacterial strains isolated were 84 (42.6%), coagulase negative Staphylococci 55 (66%) with MDRs (89%) were the most common isolates followed by Staphylococcus aureus 15 (17.8%). Different antibiotics were used against these isolates; Gram- negative isolates showed high resistance rates to ceftazidime, gentamicin, amikacin and ertapenem. A. baumannii were the most frequent MDROs (94%), and the highest resistance rates in Gram-positive strains were observed toward ampicillin, oxacillin, ampicillin/sulbactam and Cefoxitin, representing 90% of total MDR Gram-positive isolates. ESBL and MRS were identified in most of strains. The prevalence of antibiotic resistance was high for both Gram negative and Gram positive isolates. This prevalence requires strict infection prevention and control intervention, continuous monitoring, implementation of effective antibiotic stewardship, immediate, concerted and collaborative action to monitor its prevalence and spread in the hospital.

Evidence of West Nile Virus Circulation in Horses and Dogs in Libya.

West Nile virus (WNV) is a globally significant mosquito-borne Flavivirus that causes West Nile disease (WND). In Libya, evidence of WNV circulation has been reported in humans but never in animals. The aim of this study was to determine the seroprevalence of WNV infection in horses and dogs in Libya. In total, 574 and 63 serum samples were collected from apparently healthy, unvaccinated horses and dogs, respectively, between 2016 and 2019. A commercially available competitive enzyme-linked immunosorbent assay (c-ELISA) kit was initially used to test the collected samples for the presence of WNV Ig-G antibodies. Positive and doubtful sera were also tested using a more specific virus neutralisation assay to confirm whether the ELISA-positive results were due to WNV or other Flavivirus antibodies. The seroprevalence of WNV IgG antibodies according to ELISA was 13.2% out of 574 of total horses' samples and 30.2% out of 63 of total dogs' samples. The virus neutralisation test (VNT) confirmed that 10.8% (62/574) and 27% (17/63) were positive for WNV-neutralising titres ranging from 1:10 to 1:640. Univariable analysis using chi-square tests was conducted to measure the statistical significance of the association between the hypothesized risk factors including city, sex, breed, and age group and were then analyzed using the subsequent multivariable logistic regression model for horse samples. Age group was found to be the only significant risk factor in this study. The results of the present study provide new evidence about WNV circulation in Libya.

Exploiting epidemiological data to understand the epidemiology and factors that influence COVID-19 pandemic in Libya.

There were only 75 confirmed cases of coronavirus disease 2019 (COVID-19) reported in Libya by the National Center for Disease Control during the first two months following the first confirmed case on 24 March 2020. However, there was dramatic increase in positive cases from June to now; as of 19 November 2020, approximately 357940 samples have been tested by reverse transcription polymerase chain reaction, and the results have revealed a total number of 76808 confirmed cases, 47587 recovered cases and 1068 deaths. The case fatality ratio was estimated to be 1.40%, and the mortality rate was estimated to be 15.90 in 100000 people. The epidemiological situation markedly changed from mid-July to the beginning of August, and the country proceeded to the cluster phase. COVID-19 has spread in almost all Libyan cities, and this reflects the high transmission rate of the virus at the regional level with the highest positivity rates, at an average of 14.54%. Apparently, there is an underestimation of the actual number of COVID-19 cases due to the low testing capacity. Consequently, the Libyan health authority needs to initiate a large-scale case-screening process and enforce testing capacities and contact testing within the time frame, which is not an easy task. Advisably, the Libyan health authority should improve the public health capacities and conduct strict hygienic measures among the societies and vaccinate as many people against COVID-19 to minimize both the case fatality ratio and socio-economic impacts of the pandemic in Libya.

Characterization of methicillin-resistant Staphylococcus aureus isolated at Tripoli Medical Center, Libya, between 2008 and 2014.

Bacterial pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) represent a well-known public health problem affecting both healthcare-associated and community populations. Past studies have clearly shown the value of characterizing problem organisms including MRSA through the use of molecular techniques (i.e. strain typing), with the aim of informing local, regional and national efforts in epidemiological analysis and infection control. The country of Libya represents a challenge for such analysis due to limited historical infectious disease information and major political unrest culminating in the Libyan Civil War (Libyan Revolution) in 2011. A MRSA study population of 202 isolates, cultured from patients in Tripoli Medical Center through this historical period (2008-2014), was characterized by both phenotypic and molecular methods. The results revealed a diversification of epidemic MRSA strains over time with generally increasing resistance to fluoroquinolone antibiotics. The study identified prevalent MRSA in comparison to known global epidemic types, providing unique insight into the change of strains and/or characteristics over time especially with reference to the potential influence of the political revolution (i.e. pre- and post-2011).

Opportunistic infections in patients with AIDS admitted to an university hospital of the Southeast of Brazil.

Opportunistic diseases in HIV-infected patients have changed since the introduction of highly active anti-retroviral therapy (HAART). This study aims at evaluating the frequency of associated diseases in patients with AIDS admitted to an university hospital of Brazil, before and after HAART. The medical records of 342 HIV-infected patients were reviewed and divided into two groups: group 1 comprised 247 patients before HAART and, group 2, 95 patients after HAART. The male-to-female rate dropped from 5:1 to 2:1for HIV infection. There was an increase in the prevalence of tuberculosis and toxoplasmosis, with a decrease in Kaposi's sarcoma, histoplasmosis and cryptococcosis. A reduction of in-hospital mortality (42.0% vs. 16.9%; p = 0.00002) has also occurred. An agreement between the main clinical diagnoses and autopsy findings was observed in 10 out of 20 cases (50%). Two patients with disseminated schistosomiasis and 2 with paracoccidioidomycosis are reported. Overall, except for cerebral toxoplasmosis, it has been noticed a smaller proportion of opportunistic conditions related to severe immunosuppression in the post HAART group. There was also a significant reduction in the in-hospital mortality, possibly reflecting improvement in the treatment of the HIV infection.

Opportunistic infections in patients with aids admitted to an university hospital of the Southeast of Brazil

Opportunistic diseases in HIV-infected patients have changed since the introduction of highly active anti-retroviral therapy (HAART). This study aims at evaluating the frequency of associated diseases in patients with AIDS admitted to an university hospital of Brazil, before and after HAART. The medical records of 342 HIV-infected patients were reviewed and divided into two groups: group 1 comprised 247 patients before HAART and, group 2, 95 patients after HAART. The male-to-female rate dropped from 5:1 to 2:1for HIV infection. There was an increase in the prevalence of tuberculosis and toxoplasmosis, with a decrease in Kaposi's sarcoma, histoplasmosis and cryptococcosis. A reduction of in-hospital mortality (42.0 percent vs. 16.9 percent; p = 0.00002) has also occurred. An agreement between the main clinical diagnoses and autopsy findings was observed in 10 out of 20 cases (50 percent). Two patients with disseminated schistosomiasis and 2 with paracoccidioidomycosis are reported. Overall, except for cerebral toxoplasmosis, it has been noticed a smaller proportion of opportunistic conditions related to severe immunosuppression in the post HAART group. There was also a significant reduction in the in-hospital mortality, possibly reflecting improvement in the treatment of the HIV infection

Hepatosplenic schistosomiasis in field-based studies: a combined clinical and sonographic definition

A combined clinical and sonographic classification of hepatosplenic schistosomiasis mansoni to be used in field-based studies is proposed herein. Seven hundred forty one individuals out of 892 (83 percent), living in an area endemic for schistosomiasis in Brazil, have been ubmitted to clinical and ultrasound examinations. Based on two stool examinations the overall prevalence for schistosomiasis in this area was 73 percent. Abdominal palpation was performed with patients in dorsal decubit, during deep breath, by two experienced physicians and a portable ultrasound was used for the evaluation of liver fibrosis, portal collaterals and spleen size. Four groups of individuals were identified using data obtained by abdominal palpation and ultrasound examination: (1) palpable spleen and intense periportal thickening in 9 individuals (1.2 percent); (2) spleen not palpable and intense periportal thickening in 15 (2 percent); (3) palpable spleen with light to moderate periportal thickening in 32 (4.3 percent), and (4) palpable spleen with a normal liver on ultrasound in 30 (4 percent). The definition of hepatosplenic schistosomiasis in field-based studies as the finding of Schistosoma mansoni eggs in the stools in an individual with splenomegaly is not acceptable anymore. Abdominal ultrasound should be combined with clinical examination to accurately identify hepatosplenics in endemic areas for schistosomiasis

Schistosomal myeloradiculopathy due to Schistosoma mansoni: report on 23 cases

Schistosoma mansoni infection is likely to be responsible for a significant proportion of cases of myelopathy occurring in areas where schistosomiasis is endemic. The aim of this study is to describe the clinical, laboratory and therapeutic data of 23 patients with schistosomal myeloradiculopathy. The medical records of 23 patients with schistosomal myelopathy admitted to two general hospitals of Belo Horizonte (MG), in Brazil, from 1995 to 1999, were reviewed retrospectively. Seventeen patients were male (74 percent). The mean age for the whole group was 27 years. Lower limb weakness and associated lumbar and/or lower limb pain were reported by 20 patients (87 percent), and 16 (70 percent) were unable to walk. All individuals presented urinary retention and 19 (83 percent) complained of intestinal dysfunction. The treatment was based on the association of antischistosomal drugs and corticosteroids. Five patients (22 percent) presented a full response to treatment, 13 (57 percent) partial response without functional limitations and 4 (17 percent) partial improvement with limitations or no response. Three out of the 4 patients who stopped steroids before 45 days of treatment developed recurrence of the symptoms and signs of myelopathy. Our cases demonstrate the severe presentation of the disease and the data disclosed here suggest that treatment with steroids should be kept for months after clinical improvement

Pyogenic abscesses and parasitic diseases

Parasitic diseases which during their course in the host switch the immune system from a T helper 1 to a T helper 2 response may be detrimental to the host, contributing to granuloma formation, eosinophilia, hyper-IgE, and increased susceptibility to bacterial and fungal infections. Patients and animals with acute schistosomiasis and hyper-IgE in their serum develop pyogenic liver abscess in the presence of bacteremia caused by Staphylococcus aureus. The Salmonella-S. mansoni association has also been well documented. The association of tropical pyomyositis (pyogenic muscle abscess) and pyogenic liver abscess with Toxocara infection has recently been described in the same context. In tropical countries that may be an interesting explanation for the great morbidity of bacterial diseases. If the association of parasitic infections and pyogenic abscesses and/or fungal diseases are confirmed, there will be a strong case in favor of universal treatment for parasitic diseases to prevent or decrease the morbidity of superinfection with bacteria and fungi

Dengue: uma nova abordagem / Dengue: a reappraisal

Os conceitos de dengue clássico, com ou sem hemorragia, e da febre hemorrágica do dengue (FHD) que, pode cursar sem fenômenos hemorrágicos, com ou sem síndrome do choque do dengue (SCD) säo revistos neste artigo. As definiçöes clássicas propostas, úteis em outros tempos, geram confusäo e dificultam a tomada de decisöes no momento do tratamento dos pacientes com as formas graves da doença porque deixaram de incorporar novos conceitos e avanços terapêuticos. A classificaçäo do dengue proposta neste trabalho, e apresentada em fluxograma, incorpora os conceitos atuais de sepse, síndrome da resposta inflamatória sistêmica (SIRS) e síndrome da angústia respiratória do adulto (SARA). A nova classificaçäo serve de guia para orientar a conduta terapêutica inicial e aproxima o tratamento do dengue aos protocolos e rotinas já implantados nos diversos centros hospitalares de urgência, facilitando a atuaçäo dos serviços de saúde em situaçöes de surtos epidêmicos

A associaçäo entre a toxocaríase humana e os abscessos piogênicos / The association of human toxocariasis and pyogenic abscesses

A associaçäo entre o abscesso hepático e a esquistosomose mansônica foi confirmada por estudos clínicos e experimentais. Outros parasitos, como a larva de Toxocara canis, podem causar alteraçöes imunológicas sistêmicas e estruturais nos órgaos acometidos que favorecem a instalaçäo e o crescimento da bactéria. A piomiosite tropical, o abscesso hepático piogênico e o abscesso renal säo doenças freqüentes nos países tropicais e muitas vezes näo se encontra doença de base que poderia explicá-las. A síndrome de larva migrans visceral é causada pela presença no organismo humano de larvas de vermes que têm outros animais como hospedeiro definitivo sendo a T. canis o agente mais comum. As larvas migram por vários órgäos causando reaçäo inflamatória na forma de granuloma com necrose tecidual. Nesta revisäo discutem-se os possíveis mecanismos de interaçäo entre o hospedeiro, o parasito e a bactéria que podem favorecer a formaçäo de abscessos nos órgäos acometidos pela larva de T. canis e resumem-se alguns resultados preliminares de trabalho clínico-experimental realizado durante os últimos quatro anos para definir o papel deste parasito na patogenia dos abscessos

Fever of undetermined origin in patients with the acquired immunodeficiency syndrome in Brazil: report on 55 cases

The medical records of patients with AIDS admitted to a general hospital in Brazil from 1989 to 1997 were reviewed retrospectively with the aim at defining the frequency and etiology of fever of undetermined origin (FUO) in HIV-infected patients of a tropical country and to evaluate the usefulness of the main diagnostic procedures. 188 (58.4 percent) out of 322 patients reported fever at admission to hospital and 55 (17.1 percent) had FUO. Those with FUO had a mean CD4+ cell count of 98/ml. A cause of fever was identified for 45 patients (81.8 percent). Tuberculosis (32.7 percent), Pneumocystis carinii pneumonia (10.9 percent), and Mycobacterium avium complex (9.1 percent) were the most frequent diagnoses. Other infectious diseases are also of note, such as cryptococcal meningitis (5.5 percent), sinusitis (3.6 percent), Salmonella-S. mansoni association (3.6 percent), disseminated histoplasmosis (3.6 percent), neurosyphilis (1.8 percent), and isosporiasis (1.8 percent). Four patients had non-Hodgkin's lymphoma (7.3 percent). We conclude that an initial aggressive diagnostic approach should be always considered because biopsies (lymph node, liver and bone marrow) produced the highest yield in the diagnosis of FUO and the majority of the diagnosed diseases are treatable. The association of diseases is common and have contributed to delay the final diagnosis of FUO in most cases. In our study area the routine request of hemocultures for Salmonella infection and the investigation of cryptococcal antigen in the serum should be considered.

Visceral larva migrans and tropical pyomyositis: a case report

Os autores relatam o caso de um jovem com piomiosite tropical grave, eosinofilia e hiperimunoglobulinemia E. O paciente relatou historia de contato com um cao e o teste de ELISA para Toxocara canis revelou-se positivo. O Staphylococcus aureus foi a unica bacteria isolada da secrecao purulenta obtida dos abscessos musculares. Sugere-se que a piomiosite tropical possa ser iniciada pela presenca das larvas desse ou de outros parasitos com tropismo para os musculos. As alteracoes imunologicas e estruturais nos musculos acometidos pelas larvas e a presenca de bacteriemia podem favorecer a instalacao da bacteria e o desenvolvimento da piomiosite

Schistosomiasis and associated infections

In hospital-based series viral hepatitis B has been frequently described in association with schistosomiasis whilst in field-based studies the association has not been confirmed. The association between schistosomiasis and Salmonella bacteraemia has been well documented. More recently, acute schistosomiasis has been shown to be a facilitating factor in the genesis of pyogenic liver abscesses caused by Staphylococcus aureus. New evidences indicate an interaction between the acquired immunodeficiency syndrome (AIDS) and schistosomiasis. In this paper, data on the association of schistosomiasis with other infections are updated.

Splenic palpation for the evalution of morbidity due to schistosomiasis mansoni

This study was undertaken to determine the accuracy of splenic palpation for the diagnosis of splenomegaly, and to determine whether the frequency of individuals with a palpable spleen in an endemic area can be considered as an index of morbidity of schistosomiasis. For the clinical diagnosis of splenomegaly, two criteria have been tested: (A) presence of a palpable spleen and (B) presence of a palpable spleen whose border could be felt more than 4 cm below the costal margin. In an area of high prevalence of the disease (66.3 per cent) 285 individuals aged 18 years or more have been submitted to abdominal ultrasonography and physical examination. Splenomegaly was defined as a splenic lengh greater than 120 mm by ultrasound and the sensitivity, specificity, positive and negative predictive values of criterion A were 72.2 per cent, 90.5 per cent, 35.1 per cent and 97.8 per cent. The values for criterium B were 27.8 per cent, 98 per cent, 50 per cent and 95 per cent, respectively. In an non endemic area, 517 individuals were submitted to the same protocol and 22 individuals had a palpable spleen, but no patient fulfilled criterium B for splenomegaly, and only one met the ultrasonographic criterium for splenomegaly. The authors concluded that abdominal palpable is a poor method for the diagnosis of splenomegaly.

Chronic carriers of hepatitis B surface antigen in an endemic area for shistosomiasis mansoni in Brazil

Data on the association of schistosomiasis and hepatitis B in field-based studies are scarce. Two areas have been selected for this study: i) Queixadinha, endemic for shistosomiasis, with a population of 693 individuals, and ii) Capäo, a control non-endemic area, with 515 inhabitants. Sera of all individuals in both areas were tested for hepatitis B infection, yearly, from 1994 to 1997. In the first area hepatitis B was found in 32.1 per cent of children up to one year old and reached a peak of 68.7 per cent in the age range of 15 to 19 years. In the control area the prevalence of hepatitis B was under 5 per cent up to 19 years of age and the highest prevalence was observed in adults over 45. HBsAg was detected in 9.4 per cent of the individuals living in the endemic area for shistosomiasis and in 1.4 per cent of the controls (OR=4.98; 95 per centCI=3.7-6.7). The index of chronicity of HBsAg was not statistically different in the studied areas (8.1 per cent x 7.3 per cent; OR=1.09; 95 per cent CI=0.42-3.03) nor was it different for people with and without schistosomiasis in Queixadinha (8.7 per cent x 7.0 per cent). We conclude that the Schistosoma mansoni infection has not altered the course of hepatitis B in the studied area.

Salmonella-S. mansoni association in patients with acquired immunodeficiency syndrome

Apresentam-se os casos de dois jovens com bacteriemia por Salmonella associada a esquistossomose mansoni ativa em pacientes com a sindrome da imunodeficiencia adquirida. A apresentacao clinica incluiu sintomas e sinais inespecificos como fadiga, perda de peso, diarreia, febre prolongada e hepatoesplenomegalia. A biopsia hepatica em um paciente revelou granulomas mal formados em torno de ovos de S. mansoni e hepatite de intensidade moderada. O tratamento da esquistossomose com a oxamniquine induziu melhora clinica progressiva culminando com a cura da salmonelose e da esquistossomose. O reconhecimento da associacao Salmonella-S. mansoni em pacientes com AIDS mostra-se importante nesses casos pois o tratamento da esquistossomose melhora o prognostico da bacteriemia por Salmonella que pode tornar-se recorrente e fatal nos pacientes com AIDS

O emprego de psicoestimulantes no adulto / The use of psychostimulant agents in adults

Os psicoestimulantes vêm sendo empregados como potencializadores de drogas antidepressivas no tratamento de transtornos do humor refratários. Mesmo nao associados a antidepressivos, os estimulantes sao considerados úteis no paciente deprimido portador de doença física e no idoso deprimido apático, nos quais os antidepressivos encontram obstáculos, especialmente efeitos colaterais e longa latência para o início da açao terapêutica. Sao particularmente interessantes para o paciente deprimido portador de doença física crônica terminal, como a AIDS e o câncer, e para o deprimido portador de lesao encefálica residual. No transtorno de déficit de atenção e hiperatividade residual do adulto, os psicoestimulantes sao indicados. Pacientes com transtornos do humor relacionados ao complexo demencial da AIDS também parecem beneficiar-se de terapêutica com psicoestimulante. Em casos da síndrome de fadiga crônica, psicoestimulantes também têm sido considerados úteis

O emprego de psicoestimulantes no adulto

Os psicoestimulantes vem sendo empregados como potencializadores de drogas antidepressivas no tratamento de transtornos do humor refratarios. Mesmo nao associados a antidepressivos, os estimulantes sao considerados uteis no paciente deprimido portador de doenca fisica e no idoso deprimido apatico, nos quais os antidepressivos encontram obstaculos, especialmente efeitos colaterais e longa latencia para o inicio da acao terapeutica. Sao particularmente interessantes para o paciente deprimido portador de doenca fisica cronica terminal, como a AIDS (sindrome da imunodeficiencia adquirida) e o cancer, e para o deprimido portador de lesao encefalica residual. No transtorno depressivo do adulto jovem, a literatura nao respalda o emprego de psicoestimulante isolado, nao associado a antidepressivo. Na narcolepsia, os psicoestimulantes tem sido prescrito. No transtorno de deficit de atencao e hiperatividade residual do adulto, os psicoestimulantes sao indicados. Pacientes com transtornos do humor relacionados ao complexo demencial da AIDS tambem parecem beneficiar-se de terapeutica com psicoestimulante. Em casos da sindrome de fadiga cronica, psicoestimulantes tambem tem sido considerados uteis.