Introduction Analysis of surveillance data on bacterial respiratory pathogens most commonly causing bacteraemia and meningitis may be useful to measure the impact of vaccination, monitor antimicrobial resistance emergence and document changes in disease epidemiology. Materials and methods Active, laboratory-based, national surveillance for invasive Haemophilus influenzae, meningococcal and pneumococcal disease in South Africa was conducted. Isolates, cultured from normally sterile sites, were submitted for phenotypic and genotypic characterisation. Trends are described and univariate and multivariable models were used to assess differences among groups. Results Following the introduction of H. influenzae serotype b conjugate vaccine (HibCV) in 1999, the number of Hib cases reported for infants <1 year decreased by 65%, from 55 cases in 1999-2000 to 19 cases in 2003-2004. Despite high HibCV coverage, rates of Hib disease in children <5 years then increased from 0.7 per 100,000 population in 2003 to 1.3/100,000 in 2009. Among 263 Hib episodes, 135 (51%) were classified as vaccine failures and 53% of these occurred among children who were not HIV infected. An investigation of meningococcal disease in Gauteng, revealed rates of disease which increased from 0.8/100,000 in 2000 to 4.0/100,000 in 2005; the percentage due to serogroup W135 increased during this time from 7% (4/54) of cases to 75% (221/295). Overall case-fatality ratios doubled from 11% in 2003 to 22% in 2005. Our investigations revealed that the expansion of the Hajj clone explained the emergence of serogroup W135 during this time, as 95% of W135 isolates (285/301) were identified as one clone by pulsed-field gel electrophoresis and seven representative strains belonged to the ST-11/ET-37 complex. Among invasive pneumococcal disease (IPD) cases, 12 levofloxacin-non-susceptible pneumococci were identified in children <15 years, and were found to be associated with a history of tuberculosis (TB) treatment and nosocomial IPD in two treatment centres for multidrug-resistant TB (MDR TB). From 2003 through 2008, prior to pneumococcal conjugate vaccine (PCV) introduction, among IPD cases in children <5 years, 58% (3849/6668), 65% (4314/6668), and 85% (5669/6668) of cases and 61% (455/751), 64% (482/751), 82% (616/751) of deaths were due to serotypes included in 7-valent PCV (PCV-7), PCV-10 and PCV-13, respectively. PCV-13 had significantly higher coverage for isolates from blood culture than for isolates from cerebrospinal fluid: 3882/4531 (86%) vs. 1670/2009 (83%), p=0.009, but only differed by 3%. An analysis of risk factors revealed the relative risk of IPD was 21-fold (95% CI, 19–24) and 34-fold (29–41) greater in HIV-infected compared to HIV-uninfected children in the <1 year and 1–4-year-old age groups, respectively. Discussion and conclusions After initial reductions in Hib disease, vaccine failures, occurring in both HIV-infected and -uninfected children, comprised half of the rise in Hib disease detected 10 years after national introduction of Hib vaccine, given as three doses without a booster. These data contributed to the decision to add a booster dose of Hib vaccine in South Africa in 2009. Continued surveillance of meningococcal serogroup W135 revealed evidence that this serogroup had become endemic in Gauteng causing more severe disease than the previous predominant serogroup A strain. Paediatric fluoroquinolone use for MDR TB led to the emergence and nosocomial spread of levofloxacin-non-susceptible pneumococci. Existing pneumococcal vaccine formulations have the potential to prevent most cases and deaths from IPD among HIV-infected and -uninfected children in South Africa. Surveillance of pneumococcal meningitis may provide representative data for monitoring the impact of PCV.

E realizado o estudo epidemiológico das meningites de etiologia indeterminada no Municlpio de São Paulo, no período de 1960 a 1977. O trabalho é apresentado em quatro partes. Na primeira parte são apresentados e discutidos os diferentes modos de diagnóstico etiológico das meningites (presuntivos e de certeza) e é enfatizada a necessidade do estudo das meningites indeterminadas. Na segunda parte é apresentado o comportamento epidemiológico da doença meningocócica no Município de São Paulo, no período 1960 a 1977. Esta apresentação é feita visando comparar e procurando verificar a influência da doença meningocócica no comportamento epidemiológico das meningites de etiologia indeterminada. Na terceira e quarta partes são apresentados os caracteres epidemiológicos das meningites de etiologia indeterminada. Inicialmente os casos são classificados em meningites indeterminadas de provavel etiologia bacteriana ou viral, utilizando-se como parâmetro para a classificação o percentual de neutrófilos no liquor. Em seguida são apresentados e analisados os comportamentos segundo variaveis da pessoa (idade e sexo), do local de residência (segundo distritos e areas homogêneas do município), do tempo (variação anual e mensal), modo diagnóstico, evolução clinica, tempo de hospitalização. O estudo mostra que entre 1972 e 1977 ocorreu no Município de São Paulo um aumento significativo de casos de meningite de etiologia indeterminada; grande parte dos casos, provavelmente, era constituída por casos de meningite meningocócica, dos quais não foi possivel a determinação etiológica. Ocorreu também, concomitantemente, um aumento significativo de meningites de provável etiologia viral. O percentual de neutrófilos no liquor (primeiro exame) em épocas epidêmicas, pode ser utilizado como parâmetro para classificacão epidemiológica meningites segundo etiologia provavelmente bacteriana ou viral. / The epidemiological behaviour of the meningitis of undetermined etiology within the Municipality of São Paulo, during the period from 1860 to 1977, is studied. The work consists of four parts. In the first part, the different forms of etiological diagnosis of meningitis (either presumptives ar certain) are submitted and discussed, as well as the need study of the undetermined meningitis. In the second part the epidemiological behaviour of the meningococcal diseases within the Municipality of São Paulo, during the period from 1960 to 1977, is submitted. Such a presentation is made with the purpose of comparison, and trying to verify the influence of the meningococcal disease on the epidemiological behaviour of the meningitis of undetermined etiology. In the third and fourth parts, the epidemiologic characters of the meningitis of undetermined etiology are submitted. At first, the cases are classified as undetermined meningitis of probable bacterial or viral etiology, using as parameter for the classification the percentile number of neutrophiles in the liquor (first examination). Then, there are submitted and analysed the behaviour as per the variables of the person (age and sex), place of residence (according to districts and homogeneous areas within the Municipality), time (annual and monthly variation), form of diagnosis, clinic evolution, and hospitalization period. It is concluded that between 1972 and 1977 there was in the Municipality of São Paulo, an epidemics of meningitis of undetermined etiology; most of the cases were, probably, constituted by cases of meningococcic meningitis, of which it was not possible to make the etiologic determination. There was, also, al the same time, an important increase of diagnosis of meningitis of probable viral etiology. The percentile number of neutrophiles in the Liquor (first examination), in epidemic times, may be used as an epidemiological parameter for the classification of the meningitis, as per the etiology, probably bacterial or viral.

No description available.

Thesis (Msc.(Med.)(Pharmacy))--University of Limpopo, 2010 / Background Information regarding disease epidemiology, treatment options and emerging infections and resistance constantly challenge the knowledge of the health care practitioner. Antibiotic prescribing patterns was identified by the Dr George Mukhari hospital antibiotics committee as an area of concern. Due to this concern it was decided to investigate the prescribing patterns in adult patients with meningitis admitted to the internal medicine wards at Dr George Mukhari hospital. Objectives To determine the current antimicrobial prescribing patterns in adult patients diagnosed with meningitis, to record the causative organisms and sensitivity patterns, to record the outcom e, cost and length of treatment. Method Patient and prescriptions data were recorded prospectively on specially designed data sheets from five internal medicine wards for four months (May to August 2008). Patients were followed until discharged. Results Sixty-six patients were enrolled; 41 recovered, 22 died, 2 refused treatment and 1 absconded. Ceftriaxone was prescribed the most frequently and was administered to 58 patients; four patients with confirmed cryptococcal meningitis received amphotericin B IVI, three patients were started on iv Rifafour® for suspected tuberculosis meningitis and one was started on cefuroxime. Specimens from only 22 patients were sent for culture and sensitivity tests; ten were positive for yeast-like organisms, three for S pneumoniae and one for N meningitides and tuberculosis respectively. The average duration of treatment of patients with meningitis was 9.2days. The total cost of antiinfectives used for treatment of meningitis amounted to R111, 292.53 and the average cost per patient was R1 686.25. The cost of all medicines prescribed for the 66 patients amounted to R116, 490.43. Conclusion Ceftriaxone was used frequently as empiric therapy. Specimens for culture and sensitivity were not sent routinely. Therefore it was difficult to monitor and observe any resistance patterns and to contain cost of treatment.

No description available.

<I>Streptococcus pneumoniae</I> is a serious pathogen, responsible for a large proportion of cases of pneumonia, bacteraemia and meningitis. Restriction endonuclease analysis (REA) using <I>Taq </I>I and <I>Hae</I> III was evaluated to analyse the genetic relationships among 51 isolates of <I>S. pneumoniae</I> in four different serotypes. This method was used together with pulsed-field gel electrophoresis (PFGE) in the analysis of clinical isolates of bacteraemic <I>S. pneumoniae</I> in the Grampian region of Scotland during a two year period from 1993-5. A total of 104 isolates were collected, of which 93 were analysed by REA and 94 by PFGE. Sensitivities to eight commonly used antibiotics were determined for 99 isolates, and serotyping was performed by the relevant reference laboratory. Records were available for 92 patients and details of past medical history, primary site of infection and outcome were abstracted. Of the clinical isolates analysed, 1% were fully resistant to penicillin and 12% were resistant to erythromycin. The three most common serotypes were 14(23.5%), 4 (12.2%) and 23F (9.2%). The current vaccine, Pneumovax II, was calculated to provide 99.8% cover for the serotypes isolated. The overall incidence of bacteraemic infection was 10.3 per 100,000 population per year, and the mortality was 21.2%. Both the incidence and mortality increased exponentially with respect to age. In both serotype and clinically based studies, when analysed by REA and PFGE, isolates were primarily grouped into closely associated clusters of single serotypes. Some serotypes, such as 3, 6B and 14, were divided into genetically distinct subgroups. The genetics structure of the population was defined as being primarily clonal with evidence of a serotype change in one instance. An erythromycin resistant serotype 14 clone was described, and later discovered to be of the M phenotype. This clone was significantly associated with bacteraemic disease in the under 5 age group, and was demonstrated to be the current major cause of erythromycin resistance in the U.K.

Proefschrift Universiteit van Amsterdam. / Met lit.opg. - Met samenvatting in het Nederlands.

Proefschrift Universiteit van Amsterdam. / Auteursnaam op omslag: Hans Veeken. Met bibliogr., lit. opg. - Met samenvatting in het Nederlands.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 4 uppsatser.

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2003. / Also held in print (79 leaves, 30 cm.) in Wellesley Theses Collection (T 618.9282 EAT)