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Contexte : Le programme de surveillance circumpolaire internationale assure la surveillance de cinq maladies bactériennes invasives : les pneumococcies invasives, les infections invasives à streptocoque du groupe A, l’Haemophilus influenzae, les infections invasives à méningocoque et les streptocoques du groupe B. Les maladies bactériennes invasives ont une charge de morbidité plus élevée dans les populations nordiques que dans le reste du Canada. Méthodologies : Afin de décrire l’épidémiologie des maladies bactériennes invasives dans le nord du Canada de 1999 à 2018, les données relatives aux pneumococcies invasives, aux infections invasives à streptocoque du groupe A, à l’Haemophilus influenzae, aux infections invasives à méningocoque et aux streptocoques du groupe B ont été extraites du programme de surveillance circumpolaire internationale et du Système canadien de surveillance des maladies à déclaration obligatoire (SSMDO) et analysées. Résultats : Les taux d’incidence annualisés des pneumococcies invasives, des infections invasives à streptocoque du groupe A, de l’Haemophilus influenzae, des streptocoques du groupe B et des infections invasives à méningocoque étaient respectivement de 23,3, 10,5, 8,9, 1,9 et 1,1 pour 100 000 habitants. L’incidence de la pneumococcie invasive, de l’infection invasive à streptocoque du groupe A et de l’Haemophilus influenzae de type b (Hib) était respectivement 2,8, 3,2 et 8,8 fois plus élevée dans le Nord du Canada que dans le reste du pays. Les taux de maladie ont diminué de manière statistiquement significative pour la pneumococcie invasive (β = -0,02) et ont augmenté de manière statistique pour l’infection invasive à streptocoque du groupe A (β = 0,08) et l’Haemophilus influenzae sérotype a (β = 0,04) pendant la période d’étude. Dans le Nord du Canada, les taux d’incidence annualisés des pneumococcies invasives, des infections invasives à streptocoque du groupe A et de l’Haemophilus influenzae étaient statistiquement plus élevés chez les résidents autochtones que chez les résidents non autochtones. Les taux d’incidence les plus élevés ont été enregistrés dans les groupes d’âge très jeunes et plus âgés. Conclusion : Les maladies bactériennes invasives représentent une charge de morbidité importante pour les populations nordiques du Canada. Les peuples autochtones, les enfants et les personnes âgées sont particulièrement exposés.

Background: The International Circumpolar Surveillance (ICS) program conducts surveillance on five invasive bacterial diseases: pneumococcal disease (IPD), group A streptococcus (iGAS), Haemophilus influenzae (Hi), meningococcal disease (IMD) and group B streptococcus (GBS). Invasive bacterial diseases have a higher burden of disease in northern populations than the rest of Canada. Methods: To describe the epidemiology of invasive bacterial diseases in northern Canada from 1999 to 2018, data for IPD, iGAS, Hi, IMD and GBS were extracted from the ICS program and the Canadian Notifiable Diseases Surveillance System (CNDSS) and analyzed. Results: The annualized incidence rates for IPD, iGAS, Hi, GBS and IMD were 23.3, 10.5, 8.9, 1.9 and 1.1 per 100,000 population, respectively. The incidence of IPD, iGAS and Hi serotype b were 2.8, 3.2 and 8.8 times higher, respectively, in northern Canada than in the rest of Canada. Rates of disease decreased statistically significantly for IPD (β=−0.02) and increased statistically for iGAS (β=0.08) and Hi serotype a (β=0.04) during the study period. In Northern Canada, the annualized incidence rates for IPD, iGAS and Hi were statistically higher for Indigenous residents than for non-Indigenous residents. The highest incidence rates were among the very young and older age groups. Conclusion: Invasive bacterial diseases represent a high burden of disease in Canada’s northern populations. Indigenous peoples, children and seniors are particularly at risk.

Objective To determine the sensitivity to antibiotics of germs responsible for bacterial meningitis in children and the clinical course of treatment Methods This was a contemporary cross-sectional study, conducted from 15 December 2016 to 15 December 2017 in the Pediatrics Department and laboratory at Bonzola General Referral Hospital in Mbujimayi on 31 cases of meningitis aged from 1 month to 12 years. Results The prevalence of meningitis was 7.93%. The average age was 64 months with a sex ratio of 1.2 in favor of boys. Parents were of average socioeconomic status in 58.06% of cases. The clinical picture was dominated by fever and convulsions followed by consciousness disorders. The most frequently isolated bacterium was Streptococcus pneumoniae (74,19%) followed by Haemophilus influenzae (19,36%). Both showed high sensitivity to cephalosporins of 3rd generation and resistance to penicillins. Cefotaxime combined with other antibiotics or alone gave a cure rate between 58% and 78%. Overall mortality was high at 32,26% of cases. Conclusion The bacterial meningitis of the child is mainly due to Streptococcus pneumoniae, but also to Haemophilus influenzae. These germs are very sensitive to cephalosporins of 3rd generation and most often resistant to penicillins. Mortality is important around 32%. We recommend the use of antibiotics whose effectiveness is demonstrated. [ABSTRACT FROM AUTHOR]

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Résumé: Introduction : Le Niger, se situant dans la ceinture de la méningite, est confronté de façon récurrente à des épidémies dont l'ampleur varie en fonction de l'année. L'objectif de cette étude était de décrire les tendances de la méningite et d'identifier le profil des agents pathogènes incriminés dans les épidémies de méningite au Niger. Méthodes : Nous avons conduit une analyse descriptive des données de méningite de 2008 à 2015. La population d'étude était constituée par les cas suspects et confirmés de méningite. Nous avons procédé à une analyse de tous les cas suspects et confirmés de méningite notifiés au Niger de 2008 à 2015. Résultats : Au total, 6167 (40,6 %) cas confirmés de méningite ont été identifiés. De ce fait, 5507 (89,3 %), 593 (9,6 %) et 66 (1,1 %) étaient respectivement attribuables à Neisseria meningitidis, Streptococcus pneumoniae et Haemophilus influenzae. Sur les 5507 Neisseria meningitidis , 2984 (54,2 %), 1333 (24,2 %), 1165 (21,1 %), 23 (0,4 %) et 2 (0,03 %) ont été respectivement causés par les sérogroupes Neisseria meningitidis A, W, C, X et B. Conclusion : Cette étude a permis de décrire les tendances de la méningite et d'identifier le profil des agents pathogènes incriminés dans les épidémies de méningite au Niger. Une émergence de Neisseria meningitidis C est constatée. Nous recommandons la vaccination contre ce sérogroupe. Summary: Introduction: Niger, located in the meningitis belt, faces recurrent epidemics of magnitudes that vary with the year. The objective of this study was to describe the trends in meningitis and identify the profile of the microbes implicated in meningitis epidemics in Niger. Methods: We conducted a descriptive study (a secondary analysis) of meningitis data from 2008 through 2015. The study population comprised patients with suspected and confirmed meningitis. We conducted an exhaustive sampling of all suspected and confirmed meningitis cases reported in Niger from 2008 to 2015. Results: A total of 6167 (40.6 %) confirmed cases of meningitis were identified. Among them, 5,507 (89.3 %) were attributable to Neisseria meningitidis, 593 (9.6 %) to Streptococcus pneumoniae, and 66 (1.1 %) to Haemophilus influenzae respectively. Among the Neisseria meningitidis cases, 2,984 (54.2 %) were caused by serogroup A, 1,333 (24.2 %) by serogroup W, 1,165 (21.1 %) by serogroup C, 23 (0.4 %) by serogroup X, and 2 (0.03 %) by the serogroup B. Conclusion: This study enabled us to describe meningitis trends and identify the profile of the bacteria implicated in its epidemics in Niger. We observed the emergence of Neisseria meningitidis C and recommend vaccination against this serogroup. [ABSTRACT FROM AUTHOR]

Haemophilus influenzae est un hôte saprophyte du rhinopharynx chez près des deux tiers des enfants et les adultes. Neisseria meningitidis est une bactérie strictement humaine qui vit dans le rhinopharynx, pouvant provoquer une rhinopharyngite bénigne ou un état de portage asymptomatique. Nous rapportons le cas d'une pneumopathie postopératoire à association Haemophilus influenzae et Neisseria meningitidis chez un enfant diabétique. Patient âgé de 3 ans, diabétique admis au service de chirurgie cardio-vasculaire pour prise en charge chirurgicale tardive. L'évolution postopératoire a été marquée par une aggravation de l'état respiratoire, devenu encombré avec des secrétions abondantes nécessitant une hospitalisation en réanimation. Un bilan infectieux a été réalisé, notamment un prélèvement distal protégé qui a révélé une association de Neisseria meningitides et Haemophilus influenzae. A travers ce cas, nous discutons les associations bactériennes dans certaines situations à risque. Chacune de ces deux espèces est responsable d'infections diverses. Cependant l'association au même site est rare.

Abstract: Purpose: Acquired haemophilia A (AHA) is a rare bleeding disorder, due to the presence of an inhibitor directed against factor VIII (FVIII). About 50% of the AHA are idiopathic, while the remaining 50% are related to an underlying disorder or condition (autoimmune diseases, malignancies, postpartum, etc.). Patients and methods: We report on a monocentric retrospective cohort of 39 patients with AHA. Data were collected and compared to recent published data. Results: Thirty-nine patients were admitted for AHA between 1993 et 2011. Mean age at diagnosis was 71.3 years, and we noted a marked male predominance. Although the majority of patients presented a bleeding event at diagnosis (94.9%), the hemorrhagic mortality was low (2.6%). On the contrary, immunosuppressive morbidity and mortality were high in this elderly population. There was a clear correlation between initial FVIII inhibitor titer and complete remission delay. We did not identify prognostic factor for global survival. Conclusion: AHA is a rare but potentially fatal disorder. Rapidity of diagnosis and treatment initiation is crucial. Morbidity and mortality, particularly of infectious cause, due to immunosuppressive treatment, should lead to consider other available therapeutical options. [Copyright &y& Elsevier]

Abstract: Background: Since 2001 in France, a nasopharyngeal carriage study was set up for children six to 24 months old. Any data are available for older children (25 to 60 months). The aim of this study is to compare the nasopharyngeal carriage in children with acute otitis media (AOM) or healthy between both age groups (6/24 months versus 25/60 months). Moreover, during the study period, the 13-valent pneumococcal conjugate vaccine (PCV13) has replaced PCV7 in June 2010. Methods: From October 2010 to June 2011, 58 pediatricians obtained nasopharyngeal swabs from children 6–60 months with acute otitis media (AOM) or healthy controls, to analyse the carriage of pneumococcus, Haemophilus influenzae, Moraxella catarrhalis, group A streptococcus and Staphylococcus aureus. Results: Of the 1557 enrolled children, 1258 were 6 to 24 months old (315 healthy and 943 AOM) and 299 were 25 to 60 months (102 healthy and 197 AOM). More then 85% were PCV7 vaccinated and the children of 25/60 months were rarely PCV13 vaccinated (14.1%) compared to younger children (69.9%, P <0.001). For children 6/24 months, the Streptococcus pneumoniae carriage was higher in AOM group (57.3%) versus healthy (28.9%). By contrast for older children, the difference (58.4% versus 50%) was not significant. In the healthy group, older children carried more often S. pneumoniae than younger children (50% versus 28.9%, P <0.0001). This trend was also observed for H. influenzae carriage (49% versus 18.7%, P <0.0001). Multivariate analysis in the healthy group showed that siblings and day care center (or school) increased the carriage of S. pneumoniae and H. influenzae. Conclusion: These data from nasopharyngeal carriage in children 6 to 60 months old showed that pneumococcus and H. influenzae carriage is high for patients under 2 years, especially in the healthy group. Moreover, these data from the transition PCV7/PCV13, will serve as baseline in France to evaluate the impact of PCV13. [Copyright &y& Elsevier]

Summary: Urinary tract infection (UTI) is one of the most common infections in children but Haemophilus is rarely involved. In our institution, only 3 children below the age of 15years presented with UTI due to Haemophilus influenzae between January 2010 and October 2011. These children had typical symptoms of UTI: fever, abdominal pain and dysuria. In all 3 patients, standard urinalysis remained negative, but H. influenzae was found after bacterial growth in special media, i.e., blood agar (or chocolate agar). These patients had abnormalities of the urinary tract. The first patient, a 5-year-old girl, had a right ureteropelvic junction syndrome found after her UTI. The second, a 4-year-old girl, had a bilateral ureteral duplication found after many UTIs. The third, a 2-month-old boy, had a right ureteropelvic junction syndrome that had been diagnosed by prenatal ultrasound. In our hospital, during the study period, the prevalence of UTI caused by Haemophilus was 0.02% of all pediatric UTIs. There are few reports in the literature on UTI caused by Haemophilus in children (<1%): they are frequently associated with urinary tract abnormalities. The bacterium is not able to grow in usual media, so that when there is a clinical UTI with Gram negative bacilli on the direct exam but not found in the culture, an infection with Haemophilus should be discussed, and blood agar used, which is all the more important when there are underlying abnormalities of the urinary tract. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to investigate the nasal carriage of Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI) in children. Methods: Nasal samples were swabbed from children 3months to 3years of age, between December 2006 and April 2007, in 10 day-care centers in Dijon. Results: Three hundred and eighty-five children, 22.7±8.4months, were included. All were vaccinated against H1 and 92% had received at least one dose of PCV7 vaccine. HI colonization (55%) was associated with young age and concomitant pneumococcal carriage (52.4% vs. 39%). Amoxicillin/clavulanate and cefotaxime resistance rates were 17% and 0.5%. Pneumococcal carriage (48%) was increased in case of prior hospitalization. The rate of PDSP, 50%, was increased in case of recent infection (91% vs. 81%), previous antibiotherapy (64% vs. 41%), and decreased if PCV7 was completed (40.2% vs. 61,8%). There was no resistance to amoxicillin. The erythromycin resistance rate was 50.5%. 15% of the strains were vaccinal serotypes. Thirty-six and 41% of the strains were related and non-related to vaccine serotypes. Twenty-four and 11.6% of the strains were serotypes 19A and 6A respectively. Conclusion: Over the last 10years the global antibiotic resistance in children decreased for SP (22.9%) but nasal colonization remained stable due to the increase of some serotypes, such as 19A, most often resistant to antibiotics. The vaccine effectiveness against HI is optimal since no HIb serotypes were detected; resistance to betalactam is currently due equally to enzymatic mechanism and alteration of protein binding penicillin. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of our study was to identify strains of Neisseria meningitidis isolated from 2005 to 2007 in Mali. Patients and method: We carried out a cross-sectional and descriptive study of 1573 meningitidis suspected case cerebrospinal fluid (CSF) samples before antibiotherapy. The identification of isolated germs was serogroup, serotype, subtype, sequence type, and clonal complexes. Results: CSF samples were taken from children under 1 (30.1%), children between 1 and 4 (26.3%), and children between 5 and 14 years of age (25.7%). Neisseria meningitidis was identified in 144 out of 244 CSF positive samples. Streptococcus pneumoniae (73/244), and Haemophilus influenzae b (44/244) were also present. The most frequent Neisseria meningitidis serogroups were A, W135, and Y. Genotyping of the 33 live Neisseria meningitidis strains showed that three clonal complexes were present, especially serogroup A complex ST-5 with sequence type ST-7 and ST-2859, serogroup W135 complex ST-11 with sequence type ST-11, and serogroup Y complex ST-167 with sequence type ST-167 and ST-192. Discussion: The introduction of tetravalent vaccine ACYW135 should be considered in Mali and West Africa. [ABSTRACT FROM AUTHOR]

Copyright of Bulletin de la Société de Pathologie Exotique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objective: The authors had for aim to study the evolution of vaccination coverage for diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella (MMR) and Haemophilus influenzae b (Hib) in 5 to 6-year-old children in Geneva, from school year 2003–2004 to 2006–2007. Design: The data was collected from vaccination cards of 17,184 children attending public schools in the Geneva canton. Results: The average vaccination coverage over the study period was 93.4% for diphtheria, 93.5% for tetanus, 92.5% for pertussis, and 92.4% for poliomyelitis. For MMR and Hib, the coverage was 80.6, 78.4, 79.1 and 81.2% respectively. Between 2003 and 2007, an increase of coverage was observed for all vaccines. It was especially observed for MMR and Hib vaccines, even though the coverage remained below 90%. Conclusion: In the Geneva canton, epidemiological surveillance of vaccination coverage of 5 to 6-year-old children can be achieved through systematic data analysis of children''s vaccination cards. All commonly used vaccines reached the recommended coverage rates, except for MMR and Hib, even though their coverage had significantly increased. [Copyright &y& Elsevier]

Abstract: The epidemiology of bacterial meningitis has changed since the last French consensus in 1996, mainly because of more frequent Haemophilus influenzae b and pneumoccocus vaccination. A research PubMed and Cochrane databases was performed for articles published within the past 12 years, mentioning the diagnosis, surveillance, and follow-up of presumed bacterial meningitis in children. Sixty-one references were included among the 1606 on PubMed and 50 on the Cochrane databases. Additional articles (n =35) were identified using the references of selected articles. The definition of bacterial meningitis was reviewed, particularly when the causal agent was not identified. Clinical and biological criteria for the diagnosis and the place of brain imaging were updated. Guidelines available after the common use of Haemophilus influenzae vaccination were analyzed with their level of evidence. Initial surveillance data and risk factors associated with death or poor outcome were reviewed. The short and long-term follow-up was also analyzed to identify the proper follow-up for children. [Copyright &y& Elsevier]

Abstract: The epidemiology of acute community-acquired bacterial meningitis in children in industrialized nations was greatly modified because of recommended vaccination against Haemophilus influenzae b, Streptococcus pneumoniae (SP) and in some countries against Neisseria meningitidis (Nm) group C. However, most cases of bacterial meningitis are caused by SP and Nm most frequently group B, which validates the first intention use of cefotaxime or ceftriaxone combined or not with vancomycin according to the probability of pneumococcal resistance. [Copyright &y& Elsevier]

Abstract: The most frequent bacteria responsible for acute bacterial meningitis, after the neonatal period, are meningoccoci and pneumococci, very rarely Haemophilus influenzae and Listeria monocytogenes. The microbiological diagnosis is based on cell count, Gram stain, and culture of cerebrospinal fluid. Antigen detection and DNA detection are useful to identify the bacteria in cases of negative cultures, because of the fragility of some bacterial species (meningococci), or a prior antibiotic administration, before a lumbar puncture. Some tests for screening antimicrobial resistances are needed, such as those for detection of resistance to ßlactam agents in pneumococcal isolates. Blood cultures, serum samples, skin rash biopsies also contribute to the diagnosis. [Copyright &y& Elsevier]

Abstract: In 2006, the number of bacterial meningitis cases was estimated at 1375 (2.23/100,000). The leading pathogens involved in adult meningitis were, according to frequency, Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, Streptococcus agalactiae, and Haemophilus influenzae. The overall mortality rate averaged 20%, higher among patients with pneumococcal meningitis or in individuals over 65 years of age. Sequels were observed in 30% of cases and more frequent after pneumococcal meningitis. A decrease in susceptibility to antibiotics was reported for N. meningitidis, S. pneumoniae and H. influenzae. Generalized vaccination of children less than two years of age with H. influenzae type b conjugate vaccine has lead to a dramatic decrease in adult H. influenza meningitis. The few cases involved almost exclusively non-typeable strains, presenting in 12% of cases, a modified penicillin binding protein leading to a decreased susceptibility to aminopenicillins. Decreased susceptibility to amoxicillin was observed in 30% of meningococcal isolates, but all strains remained susceptible to parenteral third generation cephalosporins. Resistances to rifampicin or to ciprofloxacin, recommended in meningococcal meningitis prophylaxis, were unusual, but had to be documented. Finally, the proportion of pneumococcal strains with decreased susceptibility to beta-lactams has decreased since 2002. In adult meningitis, pneumococcal isolates with decreased susceptibility to penicillin, amoxicillin, and cefotaxime or ceftriaxone accounted for 37, 18, and 4% of cases respectively. It should be noted that for these isolates, no parenteral third generation cephalosporins MIC was above 2mg/l. Resistance to rifampin was very unusual and all pneumococcal isolates were fully susceptible to glycopeptides. [Copyright &y& Elsevier]

The aim of this study was to precise the capsular type of Haemophilus influenzae, to determine its susceptibility to β-lactam agents, and to search for an eventual clonality between the clinical strains of the pathogen. Polymerase chain reaction was carried out to confirm the capsular type and to determine the β-lactamase type. Minimum inhibitory concentrations (MICs) of β-lactam agents for H. influenzae were determined by the agar dilution method on Haemophilus test medium, and the strains were analyzed by pulsed-field gel electrophoresis after SmaI restriction. Among 157 strains of H. influenzae studied, 12.1% was of serotype b. Sixty-seven strains (42.7%) were resistant to amoxicillin, among which 51 were resistant through production of TEM-type β-lactamase while 16 showed high MICs for amoxicillin, amoxicillin + clavulanic acid, and cefuroxim, which suggested a resistance by modification of penicillin-binding proteins. Among the latter strains, five were producing TEM-type β-lactamase. Cefotaxim, cefixim, and cefpodoxim had low MICs in all cases. The pulsed-field gel electrophoresis revealed 110 pulsotypes. All H. influenzae strains, including noncapsulated strains and serotype-b encapsulated strains, had a high level of heterogeneity, with diversity indices of respectively 0.67 and 0.94. [ABSTRACT FROM AUTHOR]

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Abstract: Respiratory tract infections are a major reason of antibiotic prescription. Some of these infections can be prevented by vaccination. In France, the main new data concerns the following vaccines: Haemophilus influenzae: besides the vaccine effectiveness H. influenzae b, that is a virulent capsulated strain, a polyvalent vaccine effective against non-capsulated strains, responsible for otitis media, is under development. Pneumococci: the conjugated heptavalent vaccine recommended for all infants in the USA since the year 2000 allowed a dramatic drop in the incidence of invasive infections and of otitis media due to pneumococci, with an indirect impact reducing the frequency of pneumonia in adults. Influenza: the vaccinal coverage remains insufficient in people targeted by recommendations, particularly in health care workers. New recommendations concern some travel agents, people living in close contact with infants at risk and women immediately after delivery of a newborn at risk. Pertussis: the vaccinal coverage of preadolescents is insufficient. Vaccination of adults is mainly recommended for people who are expected to be in close contact with newborns (health care workers, parents). Tuberculosis: BCG vaccination is no longer mandatory, but is now strongly recommended for all infants in the greater Paris area, French Guyana, and for all infants at risk, especially immigrants depending on their native country. Varicella: universal vaccination is not recommended. To prevent respiratory complications in adults, the vaccine is now recommended for all varicella naive teenagers. [Copyright &y& Elsevier]

Abstract: Objectives: The aim of this study was to describe the epidemiology of H. influenzae strains collected in 2004 at the National Reference Center and to evaluate their susceptibility to various antibiotics. Methods: Demographic and clinical characteristics, capsular serotyping by slide agglutination with specific antisera, beta-lactamase by a chromogenic cephalosporin test (Nitrocefin) and MICs of amoxicillin, co-amoxiclav, cefpodoxime, cefaclor, cefuroxime, cefotaxime, erythromycin, pristinamycin and telithromycin by agar dilution method on Haemophilus Test Medium were determined for each strain. Results: 807 strains of H. influenzae were identified: 41.8% from bronchial secretions (BS), 16.2% from conjunctivitis, 6.6% from otitis media (OM), 4.2% from CSF and 8.6% from blood cultures. 95.6% of strains was not capsulated and 4.4% was of serotype b, e, or f. 26.3% of strains was beta-lactamase producing (TEM type). 185 isolates (22.8% of total strains) had reduced susceptibility to beta-lactams due to modification of the target associated or not with beta-lactamase production. When beta-lactamase was produced, the MICs of amoxicillin increased, but the activity of the other antibiotics was unchanged. Low BLNAR strains showed an increase in the MICs of all beta-lactams. This increase was weak and variable according to beta-lactams. Pristinamycin and telithromycin activities were unchanged against these strains. Two strains were resistant to erythromycin. Conclusions: Theses results show that both beta-lactamase and modifications of the target are widespread among H. influenzae strains isolated in France. Cefpodoxime remains the most active compounds against H. influenzae, whatever the resistance mechanisms, followed by pristinamycin, telithromycin, and co-amoxiclav. [Copyright &y& Elsevier]

Abstract: This review concerning the major lower respiratory tract pathogens in France has for aim to describe the epidemiology of resistance to β-lactams, macrolides, ketolides, and fluoroquinolones especially in Streptococcus pneumoniae and Haemophilus influenzae. It should also provide new insights on the mechanisms of acquired resistance and the level of resistance conferred, highlighting the related ecological impact. In the context of this XVth consensus conference, this review should contribute to the elaboration of guidelines for the treatment of lower respiratory tract infections in adults. [Copyright &y& Elsevier]

Abstract: Objective: This study had for aim to define the pattern of Haemophilus influenzae infections in a Tunisian hospital during the prevaccination era. We determined serotypes, biotypes, and antibiotic susceptibility of H. influenzae strains. Design: 187 H. influenzae strains were identified in various samples between 1999 and 2002. Results: Strains were isolated essentially from respiratory samples in 63.7% and cerebrospinal fluid in 21.4 %. The mean age of children with invasive infections was 16 months. All invasive strains belong to serotype b. Biotypes I, II and III were the most frequent (84.7%). Ampicillin resistance with betalactamase producing mechanism occurred in 26,7% of isolates, this type of resistance was more frequent among invasive strains (37.2%) than in non-invasive ones (22.8%). All betalactamase producing strains had amoxicillin MICs above 1 mg/l, these strains were susceptible to amoxicillin+clavulanate. Three strains were betalactamase negative ampicillin resistant with ampicillin MICs: 1.5, 3, and 4 mg/l. All strains were susceptible to cefotaxim with MICs<0.19 mg/l. Antibiotic resistance concerned: chloramphenicol: 7.5%, tetracycline: 6.9% and trimethoprime-sulfamethoxazole: 13.9%. 8.1% of the strains were kanamicin resistant but concerned only betalactamase producing strains. Conclusion: Before the introduction of a conjugate vaccine, all invasive infections in young children were caused by H. influenzae b strains. [Copyright &y& Elsevier]

Abstract: We reported a molecular characterization of 25 Haemophilus influenzae strains derived from cases of meningitis and sepsis in children aged less than five years hospitalized in pediatric wards from three hospitals in the Sahel area (Tunisia) during the period 1997–2002. These strains were biotyped and subjected to a capsular typing by Slide agglutination serotyping and Polymerase Chain Reaction (PCR). The genetic polymorphism of these strains was also studied in Arbitrarily Primed Polymerase Chain Reaction (AP-PCR) with two sets of primers: RAP IV and 217 δ2 as in Pulsed Field Gel Electrophoresis after digestion of the total DNA with the restriction enzyme SmaI (PFGE SmaI). Nineteen strains among 25 (76%) were of biotype I. The bexA gene was highlighted in 13 strains (52%) and in all the cases it was of the type b. Twelve strains (48%) were shown to be unencapsulated by PCR. AP-PCR RAP IV (23 genotypes/25 with a discrimination index ID=0.993) had shown nearly the same discriminatory power than PFGE (20 genotypes/21 strains with a discrimination index ID=0.995). We thus note, how capsular typing by PCR is more sensitive than slide agglutination serotyping. We also note the genetic diversity of the invasive strains isolated with a remarkable presence of non typable strains. AP PCR seems to be an alternative of choice for the epidemiologic follow-up of the Haemophilus influenzae invasive infections. [Copyright &y& Elsevier]

Abstract: Objective. – The aim of this study was to analyze the distribution of bacteria responsible for community-acquired meningitis and the pattern of resistance of common species. Design. – All bacteriologically confirmed cases of community-acquired meningitis were recorded between 1993 and 2001. Results. – Two hundred twenty-four cases of bacterial meningitis were recorded. The most frequent species were Haemophilus influenzae and Streptococcus pneumoniae followed by Neisseria meningitidis with respectively 37.1%, 32.1%, and 10.7% of cases. The yearly distribution of these bacteria did not show any epidemic peak. Enterobacteria and group B Streptococcus were the most frequently identified pathogens in neonatal meningitis. H. influenzae was the predominant microorganism in children between one month and five years of age, (66.4%) followed by S. pneumoniae (23.5%). S. pneumoniae was the predominant bacteria responsible fore more than half of the cases over five years of age. 28.8% of H. influenzae strains produced β-lactamase. 27.2% of S. pneumoniae strains were less susceptible to penicillin. Resistance rates for amoxicillin and cefotaxime were respectively 10.6% and 7.5%. Only one strain of N. meningitidis (4.2%) presented with a decreased susceptibility to penicillin. Conclusions. – In our study, H. influenzae and S. pneumoniae were the main microorganisms responsible for community-acquired meningitis. High resistance rates were found for these bacteria: 28.8% of H. influenzae to ampicillin and 27.2% of S. pneumoniae to penicillin. [Copyright &y& Elsevier]

Les bactéries encapsulées (comme Haemophilus influenzae type b [Hib], Neisseria meningitidis ou Streptococcus pneumoniae) visent les nourrissons et les jeunes enfants qui, d’une part, n’ont plus d’antigènes (Ag) maternels et, d’autre part, ont un système immunitaire inefficace contre les Ag thymo-indépendants comme les polyosides capsulaires. Les vaccins polysaccharidiques conjugués transforment le polyoside en lui faisant adopter le comportement immunologique d’un Ag thymo-dépendant, ce qui permet la mise en place d’une réponse immunitaire protectrice chez le nourrisson. Là où les vaccins conjugués furent introduits dans les programmes de vaccination du nourrisson, l’incidence des infections dûes à Hib, au méningocoque du sérogroupe C, ou au pneumocoque ont chuté d’au moins 80 % : un large succès de santé publique. De plus, le suivi épidémiologique a démontré que les vaccins conjugués induisent une immunité de groupe, liée à leur effet bénéfique sur la colonisation rhinopharyngée du nourrisson. Les applications potentielles de la technologie de conjugaison à l’élargissement du nombre des sérogroupes capsulaires visés par les vaccins méningococciques ou pneumococciques sont prometteuses. Mots clés : vaccins polysaccharidiques conjugués, efficacité, protection de groupe, programme de vaccination, réponse immunitaire Encapsulated bacterial pathogens (e.g. Haemophilus influenzae type b [Hib], Neisseria meningitidis, or Streptococcus pneumoniae) target infants and young children who have lost any protective anti-capsular antibodies supplied maternally and whose immune systems are ineffective against T-independent antigens such as the polysaccharides of the capsule. The polysaccharide-protein conjugate vaccines overcome this limitation by converting the polysaccharide to a T-dependent antigen, which allows a vaccinated infant to mount a protective immune response. Where conjugated vaccines have been introduced into paediatric vaccination schedules, the incidence of invasive diseases caused by Hib, the group C meningococcus, or the pneumococcus has plummeted by at least 80%, a major public health success. Furthermore, surveillance has demonstrated that the conjugate vaccines provide ‘herd protection’ through their beneficial impact on nasopharyngeal colonisation among vaccinated children. Promising future approaches include enhancement of the number of capsular serogroups targeted by the meningococcal or pneumococcal conjugate vaccines. Keywords: conjugated polysaccharide vaccine, effectiveness, herd protection, immunisation programmes, immune response [ABSTRACT FROM AUTHOR]

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Background. – The generalization of the vaccination against H. influenzae b (Hib), according to its integration in the French vaccinal calendar, led to the incidence decrease of the purulent meningitis with Hib in young children, which became a so rare event.Case report. – We described the case of a 14-months-old child showing a bacterial purulent meningitis with Hib, despite of a well driven vaccination.Discussion. – The epidemiology of bacterial meningitis was upset by the generalization of the anti-H. influenzae b vaccination. The use of combined vaccines specially reduced the incidence and the gravity of this pathology. Nevertheless, in spite of the excellent vaccinal coverage, the limited but real persistence of epiglottis or meningitis due to H. influenzae b should keep in mind of the biologists and the clinicians. Indeed, the chronic nasopharyngal carriage, the existence of not vaccinated or not answering people allow to consider the persistent risk of H. influenzae b bacterial meningitis. [Copyright &y& Elsevier]

Twenty-six strains of Haemophilus influenzae, isolated from diverse pathological products in two different hospitals in the center of Tunisia (Sousse-Monastir) have been compared with two different genotypic techniques: AP-PCR and pulsed-field gel electrophoresis. These two techniques showed a high discriminating power. The combination of the results of both techniques were complementary and have individualized twenty-five heterogeneous patterns among the twenty-six strains. Among the strains of respiratory origin, only two were identical, they have been isolated from two patients hospitalized in the same period and the same hospital. Excepted the two above mentioned cases, this study showed a high genetical heterogeneity of the strains. [Copyright &y& Elsevier]

The aim of this study was to describe the epidemiology of H. influenzae strains collected in 2001 at the National Reference Center and to evaluate their susceptibility to ß-lactams.Methods. – The demographic characteristics were recorded for each strain, then were determined their capsular serotyping (slide agglutination with specific antisera), as well as their ß-lactamase production (chromogenic cephalosporin test, Nitrocefin), and their MICs (agar dilution method on Haemophilus Test Medium) for amoxicillin (AMX), co-amoxiclav (AMC), cefpodoxime (CPD), cefaclor (CEC), cefuroxime (CXM), and cefotaxime (CTX).Results. – 41.3% of the 752 strains were identified in bronchial secretions, 20.6% in conjunctivitis, 11.3% in otitis media, and 11% in blood cultures. 96.3% of the strains were not capsulated and 3.7% were of type b, d, e or f. 33.8% of the strains were ß-lactamase producers (TEM type), 45.8% of these were identified in otitis pus and 27.7% in bronchial secretions. One hundred and forty-two strains (18.9%) presented reduced susceptibility to ß-lactams (modification of target) associated or not with bla+. MICs 50/90 against bla+ strains were: AMX 1/32, AMC 0.12/1, CTX 0.007/0.03, CPD 0.03/0.12, CEC 1/64, CXM 0.25/1. Against low BLNAR and bla+ strains, MICs 50/90 were: AMX 2/32, AMC 0.25/2, CTX 0.015/0.06, CPD 0.06/0.25, CEC 4/64, CXM 0.25/4. And against low BLNAR strains MICs 50/90 were: AMX 0.25/8, AMC 0.25/8, CTX 0.015/0.12, CPD 0.06/0.50, CEC 4/32, CXM 0.25/4.Conclusions. – Both bla+ and modifications of PBP are widespread among strains isolated in France. CTX, and CPD remain the most active compounds whatever the resistance mechanisms. [Copyright &y& Elsevier]

Method. – A French multicentric survey was made between December 2000 and March 2001 on 734 children (6 months–6 years) presenting with acute otitis media (AOM).Results. – A total of 1133 bacterial strains were isolated from nasopharyngeal secretions, the 3 main pathogens were S. pneumoniae (409 isolates, 36%), H. influenzae (328 isolates, 29%) and M. catarrhalis (275 isolates, 24%). The overall NP carriage rate for S. pneumoniae reached 56%. Among the 409 pneumococcal strains, 63% showed reduced susceptibility to penicillin (PRSP). Thirty two percent of PRSP isolates belonged to serotype 19, the other predominant resistant serotypes were 23, 6, 14 and 9. The analysis of PRSP strain distribution showed that resistance concerned all of France and was homogeneous, with an incidence superior to 50% in all regions, except for Alsace. H. influenzae was isolated from nasopharyngeal flora in 45% of children. 43% of H. influenzae isolates produced a β-lactamase with large variations in regional distribution (13–64 % of isolates). The overall NP carriage rate for H. influenzae was 19%. Less than 1% of H. influenzae isolates were ampicillin-resistant without producing β-lactamase. Nasopharyngeal carriage rate for M. catarrhalis was 37%, with 97% of isolates producing β-lactamase.Conclusion. – Evidence of geographical variation in the incidence of PRSP and β-lactamase-producing H. influenzae stresses the need of therapeutic policies adapted to regional epidemiology. The introduction of the heptavalent pneumococcal conjugate vaccine and the diversification of first-line antibiotherapy can only have beneficial effects in terms of cost and bacterial epidemiology. [Copyright &y& Elsevier]

Objective. – To determine the bacterial causal agents of meningitis and their pattern of resistance, in children more than one month to 14 years of age.Methods. – A 2 years, prospective study (June 1998 to June 2000) on bacterial meningitis in children was carried out in the main hospitals in Antananarivo. The enrollment criteria upon admission were fever with symptoms of meningitis and/or convulsions and/or coma. A lumbar puncture was systematically performed in each child. The aspect of the cerebrospinal fluid was described, the level of protein and glucose estimated, soluble antigens measured. Following the examination of a Gram straining, an aliquot of the fluid was cultured on specific medium. Antimicrobial sensitivity testing of isolated pathogens was performed.Results. – Bacterial meningitis was confirmed in 119 children  : 95 (80%) and 111 (93%) were less than 12 and 24 months of age, respectively. The sex distribution was 1 : 1. Three predominant microorganisms were identified : Streptococcus pneumoniae (45%), Haemophilus influenzae b (43%) and Neisseria meningitidis (10%) of which ten of 12 cases were belonging to serogroup B. The other microorganisms isolated were E.coli (2%). S. pneumoniae were found to be sensitive to penicilin G and H. influenzae were found to be sensitive to the third generation cephalosporins. Seven percent of the S. pneumoniae strains were mildly resistant (R+I) to chloramphenicol and between 29 and 50 % to aminoglucosides. A moderate resistance against gentamicin and amoxicillin was found in 22–29 % of the H. influenzae strains. The mortality rate was high (31%) and among the surviving children 30% presented with neurosensitive disorders.Conclusion. – According to these data we may recommend the inclusion of vaccination against H. influenzae in the children immunization program in Madagascar. The early diagnosis and treatment with appropriate antibiotics, such as third generation of cephalosporins, are other critical measures to be taken in order to reduce the risk of developing severe complications associated to bacterial meningitis. [Copyright &y& Elsevier]

Clinical study – The in vitro activity (MIC) of 9 β-lactam agents was determined against 280 clinical isolates of H. influenzae exhibiting various mechanisms of resistance to ampicillin.Results – When β-lactamase was produced (the most frequent mechanism of antibiotic-resistance in H. influenzae) the MICs of amoxicillin were increased and, for the majority of these strains, the activity of the other β-lactam antibiotics was unchanged except for a few β-lactamase producing strains exhibiting less susceptibility to co-amoxiclav and cephalosporins. The study on 85 ampicillin resistant non-β-lactamase-producing H. influenzae strains of strains (ARNBL) showed an increase in the MICs of all β-lactam-agents. This increase was weak and variable according to β-lactam-agents and to the strains: the modal MIC value was increased 2 times for cefixime, cefotaxime, imipenem and 4 times for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, cefpodoxime, and ceftriaxone. The clinical consequences are unknown; these strains are still rare and the resistance level is low. Understanding the intricacy of resistance mechanisms should lead to the development of reliable tests for the detection of such strains. [Copyright &y& Elsevier]

A retrospective study was conducted at the Sfax hospitals between 2013 and 2014 to study the susceptibility to antibiotics of Haemophilus influenzae after the introduction of Hib vaccination in Tunisia. Capsular typing was done by PCR. MICs for β-lactams were determined by E-test ® . The bla TEM , bla ROB and ftsI genes were searched using PCR. Among the 259 strains of H. influenzae isolated, 248 (95.7%) were non-invasive. Five strains were encapsulated (3 type b and 2 type c). Resistance rates were 33.4% for ampicillin, 10.4% for amoxicillin-clavulanic acid, 2.3% for cefixime, 1.1% for cefotaxime and 1.9% for fluoroquinolones. Among the strains resistant to β-lactams, 67 produced β-lactamase type TEM and 40 had a modification of PLP3. This study shows the change in the epidemiology of H. influenzae induced by vaccination with a dramatic decrease of invasive infections. Replacement with other capsular types or with non-typable strains that may be resistant to antibiotics requires continuous surveillance for H. influenzae infections., Competing Interests: The authors have no conflicts of interest to declare