Candida auris, a recently recognized, often multidrug-resistant yeast, has become a significant fungal pathogen due to its ability to cause invasive infections and outbreaks in healthcare facilities which have been difficult to control and treat. The extraordinary abilities of C. auris to easily contaminate the environment around colonized patients and persist for long periods have recently resulted in major outbreaks in many countries. C. auris resists elimination by robust cleaning and other decontamination procedures, likely due to the formation of ‘dry’ biofilms. Susceptible hospitalized patients, particularly those with multiple comorbidities in intensive care settings, acquire C. auris rather easily from close contact with C. auris-infected patients, their environment, or the equipment used on colonized patients, often with fatal consequences. This review highlights the lessons learned from recent studies on the epidemiology, diagnosis, pathogenesis, susceptibility, and molecular basis of resistance to antifungal drugs and infection control measures to combat the spread of C. auris infections in healthcare facilities. Particular emphasis is given to interventions aiming to prevent new infections in healthcare facilities, including the screening of susceptible patients for colonization; the cleaning and decontamination of the environment, equipment, and colonized patients; and successful approaches to identify and treat infected patients, particularly during outbreaks.
Abstract BackgroundAn increasing proportion of women are being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy. Intrauterine viral infections induce an increase in the levels of proinflammatory cytokines, which inhibit the proliferation of neuronal precursor cells and stimulate oligodendrocyte cell death, leading to abnormal neurodevelopment. Whether a maternal cytokine storm can affect neonatal brain development is unclear. The objective of the present study is to assess neurodevelopmental outcomes in neonates born to mothers with SARS-CoV-2 infections during pregnancy. MethodsIn this prospective cohort study, the neurodevelopment status of infants (N=298) born to women with SARS-CoV-2 infections during pregnancy was assessed at 10-12 months post discharge using the Ages and Stages Questionnaire, 3rd edition (ASQ-3). The ASQ-3 scores were classified into developmental delays (cutoff score: ≤2 standard deviations (SDs) below the population mean) and no delay (score >2 SDs above the population mean).ResultsApproximately 10% of infants born to mothers with SARS-CoV-2 infections during pregnancy showed developmental delays. Two of 298 infants tested positive for SARS-CoV-2, and both had normal ASQ-3 scores. The majority of the pregnant women had SARS-CoV-2 infection during their third trimester. The risk of developmental delays among infants was higher in those whose mothers had SARS-CoV-2 infections during the first (P=0.039) and second trimesters (P=0.001) than in those whose mothers had SARS-CoV-2 infections during the third trimester. Infants born at <31 weeks gestation were more prone to developmental delays than those born at >31 weeks gestation (10% versus 0.8%; P=0.002).ConclusionThe findings of the study highlight the need for long term neurodevelopmental assessment of infants born to mothers with SARS-CoV-2 infection.
Guidelines recommend universal screening of all pregnant women at 35-37 weeks of gestation for group B streptococcus (GBS) colonization and reserve a risk-factor-based approach for women who have no prenatal cultures. This study determines the prevalence of GBS among pregnant women in Lebanon and assesses the association between risk factors and vaginal flora in this patient population and antibiotic resistance pattern of the GBS isolates. Vaginal samples from women between 35-37 weeks of gestation were obtained and cultured on 5% sheep blood agar (BA), colistin nalidixic acid agar, Strep B Select chromogenic agar and Lim enrichment broth. Also, vaginal flora was evaluated on Gram-stained smears. Colonies on BA suggestive of GBS were identified by Gram staining, catalase test and agglutination in group B antiserum. Antimicrobial susceptibility to different antibiotics was tested on BA. Risk factors were obtained. The prevalence of vaginal GBS colonization was 18.4% (31/168). Evaluation of Gram-stained vaginal smears revealed an inverse relationship between the presence of lactobacilli and GBS colonization (p=0.029). Resistance of GBS to erythromycin and clindamycin was found to be 25.8% and 12.9%, respectively. Demographic and obstetric data did not reveal statistically significant differences in GBS colonization rates between age groups (p=0.498) or level of education (p=0.696) among these women. Prevalence of GBS remains high in this region with no identifiable risk factors for its acquisition. Furthermore, increase in resistance to erythromycin and clindamycin should prompt susceptibility testing of all GBS isolates. The resistance profile of these strains represents an emerging public health concern that needs further surveillance.
Antimicrobial resistance is a significant global issue that presents an increasing threat to patients' wellbeing. Although a global concern, the emergence of multi-drug resistant organisms is of particular significance in the Middle East. In recent years, this region has seen an alarming increase in antimicrobial resistance presenting a major challenge to physicians managing various infectious diseases. A Working Group comprising experts in infectious diseases from Arab countries of Middle East assembled to review similarities and differences in antimicrobial practices and management of multi-drug resistant organisms across the region and assess the barriers to achieving cross-regional collaboration. The Working Group conducted an anonymous online survey to evaluate current practice and understanding of management of multi-drug resistant organisms across the region. A total of 122 physicians from Arab countries of the Middle East responded to the survey. Their responses demonstrated heterogeneity between countries in awareness of local epidemiology, management of multi-drug resistant organisms and antimicrobial stewardship practices. The Working Group recognized similarities and differences in the management of multi-drug resistant organisms across the region, and these were validated by the data collected in the survey. Overall, the similarities across the region reflect several key issues that can have an impact on the management of multi-drug resistant organisms and the prevention of antimicrobial resistance. This paper highlights the urgency of addressing antimicrobial resistance in Arab countries of the Middle East. The Working Group identified key barriers to effective management which may guide the development of future coherent strategies to promote effective antimicrobial stewardship in the region. Here, we outline a call to action for the region, with a need to focus on training and education, capacity building, infrastructure, regional research, and regional surveillance.
The purpose of this review is to give an up-to-date, thorough, and timely overview of monkeypox (Mpox), a severe infectious viral disease. Furthermore, this review provides an up-to-date treatment option for Mpox. The monkeypox virus (MPXV) has remained the most virulent poxvirus for humans since the elimination of smallpox approximately 41 years ago, with distribution mainly in central and west Africa. Mpox in humans is a zoonotically transferred disease that results in symptoms like those of smallpox. It had spread throughout west and central Africa when it was first diagnosed in the Republic of Congo in 1970. Mpox has become a major threat to global health security, necessitating a quick response by virologists, veterinarians, public health professionals, doctors, and researchers to create high-efficiency diagnostic tests, vaccinations, antivirals, and other infection control techniques. The emergence of epidemics outside of Africa emphasizes the disease’s global significance. A better understanding of Mpox’s dynamic epidemiology may be attained by increased surveillance and identification of cases.
Measles is an RNA virus infectious disease mainly seen in children. Despite the availability of an effective vaccine against measles, it remains a health issue in children. Although it is a self-limiting disease, it becomes severe in undernourished and immune-compromised individuals. Measles infection is associated with secondary infections by opportunistic bacteria due to the immunosuppressive effects of the measles virus. Recent reports highlight that measles infection erases the already existing immune memory of various pathogens. This review covers the incidence, pathogenesis, measles variants, clinical presentations, secondary infections, elimination of measles virus on a global scale, and especially the immune responses related to measles infection.
Fungi are an important part of the atmospheric ecosystem yet an underexplored group. Airborne pathogenic fungi are the root cause of hypersensitive and allergenic states highly prevalent in Kuwait. Frequent dust storms in the region carry them further into the urban areas, posing an occupational health hazard. The fungal population associated with the respirable (more than 2.5 µm) and inhalable (2.5 µm and less) fractions of aerosols is negligibly explored and warrants comprehensive profiling to pinpoint tAhe health implications. For the present investigation, aerosol was collected using a high-volume air sampler coupled with a six-stage cascade impactor (Tisch Environmental, Inc) at a rate of 566 L min−1. The samples were lysed, DNA was extracted, and the internal transcribed regions were sequenced through targeted amplicon sequencing. Aspergillus, Penicillium, Alternaria, Cladosporium, Fusarium, Gleotinia and Cryptococcus were recorded in all the size fractions with mean relative abundances (RA%) of 17.5%, 12.9%, 12.9%, 4.85%, 4.08%, 2.77%, and 2.51%, respectively. A weak community structure was associated with each size fraction (ANOSIM r2 = 0.11; p > 0.05). The Shannon and Simpson indices also varied among the respirable and inhalable aerosols. About 24 genera were significantly differentially abundant, as described through the Wilcoxon rank sum test (p < 0.05). The fungal microbiome existed as a complex lattice of networks exhibiting both positive and negative correlations and were involved in 428 functions. All the predominant genera were pathogenic, hence, their presence in inhalable fractions raises concerns and poses an occupational exposure risk to both human and non-human biota. Moreover, long-range transport of these fungi to urban locations is undesirable yet plausible.
Abstract Background: Vaginal candidiasis is frequently prevalent in pregnant women and is associated with sepsis and adverse neonatal outcomes. This study determined the presence of Candida species in symptomatic pregnant women and evaluated the antifungal susceptibility profile of the isolated strains. It also aimed to explore whether Candida species predicts gestational complications and adverse neonatal outcomes. Methods: A total of 258 pregnant women at 35 to 37 week of gestation participated in this study. Vaginal swabs from these patients were collected at various obstetrics and gynecology clinics in Lebanon for a period of 12 months. Candida isolates were identified at species level and antifungal susceptibility of Candida albicans to fluconazole (FCZ), amphotericin B (AMB), itraconazole (ICZ) and voriconazole (VCZ) was determined by the agar-based E-test method. Results: Among 258 women tested, 100 (39%) were positive for Candida species. C. albicans, C. glabrata and C. krusei were isolated from 42%, 41% and 17% of the women, respectively. C. albicans had significant positive associations with gestational diabetes while C. kreusi or C. glabrata had significant positive associations with gestational complications and vaginal discharge. The antifungal susceptibility tests of C. albicans isolates revealed 97.5%, 90%, 87.5% and 97.5% susceptibility to AMB, FCZ, ICZ and VCZ, respectively. . Conclusion: The current study revealed high incidence of both C. albicans and non-C. albicans strains causing vulvovaginitis among pregnant women in Beirut, Lebanon. Whereas the susceptibility rates of C. albicans against AMB and VCZ were high, FCZ and ICZ proved comparatively less efficacious. The resistance profile of circulating C. albicans among pregnant women can predict the best outcome of appropriate prophylaxis or treatment of neonatal candidiasis. Vaginal candida colonization might lead to adverse neonatal outcome or gestational complications thus Candida screening as antennal follow up is advised.
SARS-CoV-2, responsible for COVID-19, shares 79% and 50% of its identity with SARS-CoV-1 and MERS-CoV, respectively. It uses the same main cell attachment and entry receptor as SARS-CoV-1, which is the ACE-2 receptor. However, key residues in the receptor-binding domain of its S-protein seem to give it a stronger affinity for the receptor and a better ability to hide from the host immune system. Like SARS-CoV-1 and MERS-CoV, cytokine storms in critically ill COVID-19 patients cause ARDS, neurological pathology, multiorgan failure, and increased death. Though many issues remain, the global research effort and lessons from SARS-CoV-1 and MERS-CoV are hopeful. The emergence of novel SARS-CoV-2 variants and subvariants raised serious concerns among the scientific community amid the emergence of other viral diseases like monkeypox and Marburg virus, which are major concerns for healthcare settings worldwide. Hence, an updated review on the comparative analysis of various coronaviruses (CoVs) has been developed, which highlights the evolution of CoVs and their repercussions.
Candida auris, a multidrug-resistant species, has the propensity of nosocomial transmission despite normal decontamination procedures. Here, we describe the isolation of C auris from patients in various hospitals in Kuwait during 2014-2018. Susceptibility to antifungal drugs and molecular basis of resistance to fluconazole, voriconazole and micafungin were also studied.Candida auris (n = 314) obtained from 126 patients in eight hospitals were studied. All isolates were identified by PCR amplification and/or PCR-sequencing of ribosomal DNA (rDNA). Antifungal susceptibility was determined by Etest. Molecular basis of resistance to fluconazole and micafungin was studied by PCR-sequencing of ERG11 and FKS1 genes, respectively.Bloodstream (n = 58), urine (n = 124), respiratory (n = 98) and other (n = 34) specimens yielded 314 C auris isolates. The proportion of bloodstream C auris among all yeast isolates was higher (42 of 307, 13.7%) in 2018 as compared to 2014-2017 (16 of 964, 1.7%) (P = .001). More bloodstream isolates (42 of 139) were cultured in 2018 than during 2014-2017 (16 of 175) (P = .001). Resistance to amphotericin B, fluconazole, voriconazole and micafungin was detected in 27.1%, 100%, 41.1% and 1.7% isolates, respectively. Fluconazole-resistant isolates contained either Y132F or K143R mutation in ERG11. Isolates with K143R mutation were additionally resistant to voriconazole. Micafungin-resistant isolates contained S639F mutation in hot spot 1 of FKS1.Our study highlights spreading of C auris in major hospitals across Kuwait and its increasing role as a bloodstream pathogen in 2018. Cross-resistance to voriconazole was also seen in isolates with K143R mutation in ERG11, while micafungin-resistant isolates harboured S639F mutation in hot spot 1 of FKS1.
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