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Infectious diarrhea affects over four billion individuals annually and causes over a million deaths each year. Though not typically prescribed for treatment of uncomplicated diarrheal disease, antimicrobials serve as a critical part of the armamentarium used to treat severe or persistent cases. Due to widespread over- and misuse of antimicrobials, there has been an alarming increase in global resistance, for which a standardized methodology for geographic surveillance would be highly beneficial. To demonstrate that a standardized methodology could be used to provide molecular surveillance of antimicrobial resistance (AMR) genes, we initiated a pilot study to test 130 diarrheal pathogens (Campylobacter spp., Escherichia coli, Salmonella, and Shigella spp.) from the USA, Peru, Egypt, Cambodia, and Kenya for the presence/absence of over 200 AMR determinants. We detected a total of 55 different determinants conferring resistance to ten different categories of antimicrobials: genes detected in &ge, 25 samples included blaTEM, tet(A), tet(B), mac(A), mac(B), aadA1/A2, strA, strB, sul1, sul2, qacE&Delta, 1, cmr, and dfrA1. The number of determinants per strain ranged from none (several Campylobacter spp. strains) to sixteen, with isolates from Egypt harboring a wider variety and greater number of genes per isolate than other sites. Two samples harbored carbapenemase genes, blaOXA-48 or blaNDM. Genes conferring resistance to azithromycin (ere(A), mph(A)/mph(K), erm(B)), a first-line therapeutic for severe diarrhea, were detected in over 10% of all Enterobacteriaceae tested: these included &gt, 25% of the Enterobacteriaceae from Egypt and Kenya. Forty-six percent of the Egyptian Enterobacteriaceae harbored genes encoding CTX-M-1 or CTX-M-9 families of extended-spectrum &beta, lactamases. Overall, the data provide cross-comparable resistome information to establish regional trends in support of international surveillance activities and potentially guide geospatially informed medical care.

Introduction: The present study, conducted between January 2004 and April 2007, explored the impact of household hygiene on the risk of bacterial diarrhea, using data from a prospective birth cohort of 348 infants in five villages in the Nile Delta in Egypt. Methodology: Neonates were enrolled at birth and followed up until 24 months of age. Children were visited twice a week to survey them for acute diarrhea. A detailed observational household hygiene survey was completed in-house every six months. Adjusted relative risk (aRR) of developing bacterial diarrhea was calculated for exposure to different hygiene variables and examined for specific bacterial pathogens. Results: Exclusive breastfeeding reduced the risk of bacterial diarrhea by 70%, while bacterial diarrhea cases were 2.6 times higher in the warm season. Risk of Campylobacter diarrhea increased with the absence of barriers to keep birds and animals out of the eating area, the presence of garbage containers and a bathing facility within the compound, and the presence of feces on the floor of the bathing facility. Use of municipal water for drinking and cooking was associated with a lower risk of Campylobacter diarrhea. Risk of enterotoxigenic Escherichia coli diarrhea increased with uncovered garbage containers and the presence of liquid materials in the garbage containers, but decreased with the use of tap water in the washing facility. Conclusion: The results highlight some potential targets for interventions, such as expanding municipal water supply to all houses and comprehensive mass-media awareness programs to change hygiene-promoting behaviors and practices.

SUMMARYBy conducting a case-control study in two university hospitals, we explored the association between modifiable risk behaviours and diarrhoea. Children aged Cryptosporidiumspp. Four hundred cases and controls were enrolled between 2007 and 2009. The strongest independent risk factors for diarrhoea were: presence of another household member with diarrhoea [matched odds ratio (mOR) 4·9, 95% CI 2·8–8·4] in the week preceding the survey, introduction to a new kind of food (mOR 3, 95% CI 1·7–5·4), and the child being cared for outside home (mOR 2·6, 95% CI 1·3–5·2). While these risk factors are not identifiable, in some age groups more easily modifiable risk factors were identified including: having no soap for handwashing (mOR 6·3, 95% CI 1·2–33·9) for children aged 7–12 months, and pacifier use (mOR 1·9, 95% CI 1·0–3·5) in children aged 0–6 months. In total, the findings of this study suggest that community-based interventions to improve practices related to sanitation and hygiene, handwashing and food could be utilized to reduce the burden of diarrhoea in Egyptian children aged

Aeromonas species are Gram-negative, oxidasepositive rods in the family Aeromonadaceae . These organisms have been isolated from untreated drinking water and different types of foods particularly seafood and frozen chicken. Aeromonas species are recognized as agents of serious infections in immunocompromised individuals including septicemia in patients with hepatic cirrhosis with a rapidly fatal outcome. Significant association of Aeromonas species with diarrhoea, particularly in children, and soft tissue infections following water-related injuries were reported from several developing countries. (Published: 24 May 2013) Citation: Libyan J Med 2013, 8: 21320 - http://dx.doi.org/10.3402/ljm.v8i0.21320