Introduction: The aim of the study was to compare resistance rate against anti-retrovirals in two cohorts of children with HIV one perinatally infected from Cambodia and the other nosocomially infected in Kyrgyzstan. Patients and Methods: Two groups of HIV positive children were compared: Vertically infected Khmer children in Cambodia and nosocomially infected children in 3 hospitals in Kyrgyzstan. Results: Prevalence of S. aureus and other oral cavity comensual was much lower in Kyrgyz children in comparison to Khmer children in Original Articles 36 Clinical Social Work and Health Intervention Clinical Social Work and Health Intervention Vol. 7 No. 3 2016 Introduction Viral, parasitic, bacterial and fungal co-infections are very frequently present among HIV positive children and such conditions often require administration of antibiotics during their therapy (1-2). The spectrum of infections occurring in HIV positive children is wide and use of antibiotic prophylaxis can stimulate development of resistance (3-4). We aimed to evaluate the spectrum of infections among pediatric HIV patients receiving HAART (Highly Active Retroviral Therapy) and to assess resistance rates of those microorganisms in the two groups of children with HIV. Methods Samples obtained from 51 HIV-positive children from Osh, Bishkek, Jalal-Abad, Kara-Suu and Nookatsk, Kyrgyz Provinces who have been receiving HAART for 3 years, were included. During their previous hospital stays, children were frequently treated with ampicillin. Cultivations from samples were performed and antibiotic profiles were assessed. A group of 51 children from Kyrgyzstan was compared to 141 children from Phnom Penh and Sihanoukville. Cambodia has a 15 year follow-up program in HIV. Tab. 1 Spectrum of microorganisms colonizing the respiratory tract in Kyrgyz versus Cambodian children with HIV on HAART Species Kyrgyz children Khmer children P Neisseria catarrhalis 20.48% 51% p˂0,01 Moraxella catarrhalis AMP-R 7.23% 6.2% NS Streptococcus viridans PEN-R 20.48% 5.1% p˂0,01 Streptococcus pneumoniae PEN-R 9.64% 5.1% NS MSSA 10.84% 10.1% NS MRSA 2.41% 45.2% p˂0,001 CoNS Staphylococcus spp 8.43% 10.1% NS Candida albicans FLU-R 15.66% 10.1% NS Others* 4.82% 4.0% NS Notes: MSSA – methicillin-susceptible S. aureus MRSA – methicillin-resistant S. aureus Other: CoNS coagulase-negative staphylococci, *Escherichia coli (1), Proteus mirablis (1), Pseudomonas aeruginosa (1), Enterococcus faecalis (1) Cambodia due to type of treatment with HAART (inpatients versus outpatients). Conclusion: In inpatient setting of HIV positive children, ATB resistance is lower. 37 Original Articles Clinical Social Work and Health Intervention Vol. 7 No. 3 2016 Results and Discussion In 51 HIV positive children we found out Neisseria catarrhalis (20.48%), Streptococcus viridans (20.48%) and Candida albicans (15.66%) being the most frequent microorganisms. Interestingly, prevalence of staphylococci was not very high (1821.69%), and surprisingly, only 2 cases (2.41%) of MRSA were noticed (P˂0,01 – 0,001) Tab.1. Also, resistance rate among bacteria was really low, with clindamycin resistance acting as the most prevalent (5.6% of bacteria isolates), followed by ampicillin and erythromycin (4.9% and 2.8%, respectively). Resistance to 5-fluorocytosine was noted in one C. albicans isolate, with the rest of candida isolates being fully susceptible to all antifungals tested. Co-infection with 2 or 3 microorganisms was identified in 20 patients (39.22%).In Cambodian children, isolation of MRSA was significantly higher (P˂0.01 – 0,001) (Tab. 1) (6-7).

Background: The aim of the survey was to assess antimicrobial resistance dynamics and reversibility in the group of children with AIDS in Cambodia in 2003 2015. Patients: Correlation between antimicrobial (ATB) resistances in commonest respiratory isolates among 140 children with AIDS on antiretroviral therapy was studied from 2003 to 2015 in 586 isolates. Original Articles 8 Clinical Social Work and Health Intervention Clinical Social Work and Health Intervention Vol. 7 No. 3 2016 Results: All but 3 (98%) children showed a sustained CD4 increase after introduction of antiretroviral therapy (ART) followed by a decrease of ATB resistance. In our group of children restoration of the immune system decreased the number of infection diseases episodes and the proportion of multi-resistant bacterial strains. Conclusions: Less frequent use of antimicrobial therapy probably led to the decrease of multi-resistance and restoration of susceptibility of studied respiratory bacterial isolates. Results and discussion Table 1 presents trends in ATB resistance in major respiratory isolates from October 2003 to December 2015 (total of 586 isolates). Penicillin resistance in pneumococci decreased from 25% to 2% in 2015 (P<0.01); t-test for trends), MRSA from 33.3% in 2003 to 3% in 2014 and 2% in 2015 (P<0.01). Erythromycin resistance in Streptococcus pyogenes decreased from 10.5% in 2003 to 3.3% in 2015. At baseline extremely high proportion of ESBL producing Enterobacteriaceae decreased from 66.6% to 25% and such trend was also observed in Candida species and resistance to fluconazole (from 15% in 2003 to 6% in 2015). Reversibility of ATB resistance was documented on the hospital level (2) or on the community national level (1.3), however only in countries with small population (Finland, Denmark, Iceland) with centralized ATB policy. Reversibility time was 2-5 years per country and more (up to 5 years). Reversibility of susceptibility or antibiotic resistance was not yet sufficiently studied in pediatric population with specific immunodeficiency therefore it is deficient to assess, of 10 15 years in our group is comparable to e.g. 2 5 years on a nation level from Europe (5-8).

The aim of this study was to assess proportion of severe malaria among all admissions in hospital located in area with internally displaced population in South Sudan, within years 2013-2014. Diagnosis of severe malaria was done clinically, plus microscopically, plus rapid diagnostic testing (RDT) has been used since 2013. Altogether, 1438 patients (38,8%) had severe malaria clinically confirmed as fever plus severe anemia, or respiratory distress syndrome, or cerebral malaria, liver or kidney failure, or severe hypoglycemia with acidosis. Of 1438 severe malaria cases, 76 died (5,3%).

Sexually transmitted infections (STIs), including HIV, are major sexual health issues among adolescents and young adults globally, but data on the burden and trends of these diseases are sparse. We aimed to assess the trends in the burden of HIV and other STIs among adolescents and young adults aged 10–24 years from 1990 to 2019 on the global, regional, and national level.In this trend analysis based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we reported on the number, rates per 100 000 population, and average annual percentage changes (AAPCs) of incidence and disability-adjusted life-years (DALYs) of HIV and other STIs (syphilis, chlamydia, gonorrhoea, trichomonas, and genital herpes) at the global, regional, and national level among individuals aged 10–24 years. We further analysed these global trends by age, sex, and social development index (SDI). We also used joinpoint regression analysis to identify the year with the most substantial changes in global trends.Globally, the incidence of HIV among adolescents and young adults decreased from 34·5 per 100 000 population (95% uncertainty interval [UI] 29·3 to 39·7) in 1990 to 22·7 per 100 000 population (20·3 to 25·8) in 2019, AAPC –2·6 [95% CI –3·1 to –2·0]); specific years in which HIV incidence decreased significantly were 1998, 2005, and 2014. Incidence of other STIs increased from 6986·3 per 100 000 population (95% UI 5504·8–8645·0) in 1990 to 7088·7 100 000 population (5620·1–8697) in 2019 (AAPC 0·2 [95% CI 0·1–0·3]); we found a substantial decrease in the incidence of other STIs in 2011 only. The rate of decrease in the incidence of other global STIs between 2009 and 2019 was approximately one-fifth the rate of the decrease in the global incidence of HIV for the same time period (AAPC –0·7 [95% CI –0·8 to –0·7] vs AAPC –3·4 [–3·8 to –3·1]). Regionally, sub-Saharan Africa had the highest incidence and highest DALYs from HIV and other STIs, and Oceania and Eastern Europe had the largest increase in the incidence and DALYs from HIV and other STIs between 1990 and 2019. By SDI quintile, the middle-SDI countries had the largest increase in HIV incidence between 1990 and 2019 and the DALYs from other STIs in the same period decreased in all SDI quintiles. Globally, females accounted for 278 076 (65·8%) of the 0·42 million incident HIV cases in 2019 and 68 115 077 (51·6%) of the 132·0 million incident cases of other STIs. Of all age groups, adolescents aged 10–14 years had the largest increase in the incidence of other STIs between 1990 and 2019 (from 1158·9 per 100 000 population [95% UI 857·8–1556·5] in 1990 to 1215·4 per 100 000 population [893·5–1616·1] in 2019; AAPC 0·1 [95% CI 0·1–0·2]). The individual STIs with the highest incident rates varied between age groups and sex.Global HIV incidence among adolescents and young adults decreased between 1990 and 2019, with significant decreases coinciding with the implementation of antiretroviral therapy and pre-exposure prophylaxis. The incidence of other STIs in this population increased over the same period and only started decreasing in 2011, at a rate of only one-fifth of the rate of decrease of HIV. Earlier sexual health education and targeted STI screening are urgently required for adolescents and young adults.National Natural Science Foundation of China and the China Postdoctoral Science Foundation.

Community acquired bacterial (CBM) meningitis in diabetic patients was analyzed for risk factors and outcome in a cohort of 201 cases of meningitis within last 17 years: 15 patients with diabetes mellitus and meningitis were identified and compared for etiology and mortality as well as for neurologic sequellae with all CBM cases.

Malaria should not be present in altitudes more than 1800 m a.s.l. However due to global warming, highlands malaria (HM) occurs up to 2 000 m. The purpose of this study is comparison of clinical picture and prognosis of HM and compare it to malaria in endemic region of southern Sudan (endemic malaria EM) among hyper-immune population.

We investigated how many cases of bacterial meningitis in our national survey were associated with sinusitis or otitis media. Among 372 cases of bacterial meningitis within our nationwide 17 years survey, 201 cases were community acquired (CBM) and in 40 (20%) otitis media or sinusitis acuta/chronica were reported 1-5 weeks before onset of CBM. Diabetes mellitus (20% vs. 7.5%, p=0.01), alcohol abuse (35% vs. 15.4%, p=0.003) and trauma (30% vs. 14.9%, p=0.02) were significantly associated with CBM after ENT infections. Concerning etiology, CBM after sinusitis/otitis was insignificantly associated with pneumococcal etiology (50% vs. 33.8 %, NS) and significantly associated with other (L. monocytogenes, Str. agalactiae) bacterial agents (9.9 % vs. 25 %, p=0.008) . However those significant differences for new ENT related CBM had no impact on mortality (12.4 % vs. 5%, NS), failure after initial antibiotics (10 % vs. 9.5%, NS) and neurologic sequellae (12.5 % vs. 15.4 %, NS).

Within last 17 years we went through all charts of bacterial meningitis within our nationwide survey and among 372 cases we found 62 cases of MM, in 12 cases with meningococcal disease (with shock, petechial effusions or disseminated intravascular coagulation or digital gangrenes). MM was usually observed in young adults without any of investigated risk factors like neoplasia, ENT (ear, nose, throat) focuses, elderly age, sepsis, diabetes, alcoholism, trauma, neonatal VLBW etc. Trauma, diabetes mellitus, alcohol abuse and chronic sinusitis/otitis were significantly less frequently found as a risk factor for MM. Mortality was very low, only 4.8% and was lower than overall mortality in CBM (12.4%, NS). Also the proportion of neurologic sequellae (9.7%) and initial treatment failure (8. 1 %) were comparable or even lower. This positive outcome results are probably because all N. meningitis strains were susceptible to penicillin, chloramphenicol, cefotaxim) cotrimoxazol or ciprofloxacin. Other reason for low mortality was that most cases received oral antibiotic immediately, even before admission (50 of 62). 95.2% of cases survived, 90.3% without any transient neurological residual symptoms.

Meningitis associated with bacteremia is rare. Bacteremic form of meningitis occurred in 28 of 201 cases of community acquired meningitis (14%) in Slovakia within last 17 years. Bacteremic meningitis was associated with diabetes (21.4% vs. 7.5%, p=0.02) and with higher treatment failures (32.1% vs. 9.5%, p=0.01) and higher mortality (25% vs. 12.4%, NS). In univariate analysis comparing 28 cases of bacteremic community acquired bacterial meningitis (BCBM) to all CBM, no significant risk factor concerning underlying disease (cancer, ENT infection, alcohol abuses, trauma, splenectomy, etc.) or etiology was observed apart of diabetes mellitus, which was more common among bacteremic meningitis (21.4% vs. 7.5%, p=0.02). Mortality (25% vs. 12.4%, NS) insignificantly but therapy failure (32.1% vs. 9.5%, p=0.01) was significantly more frequently observed among meningitis with bacteremia. N. meningitis was the commonest causative agent (8 of 28 cases) followed by Str. pneumoniae (6), gram-negative bacteria (6), S. aureus (4) and H. influenzae (2).

Craniocerebral trauma is one of major risk factors for development of meningitis. We reviewed 30 cases of bacterial meningitis occurring in community after craniocerebral trauma. Alcohol abuse was significant risk factor occurring in trauma patients with meningitis present in 50% in our cohort (p=0.0001). The most common pathogen in posttraumatic meningitis was Str. pneumoniae (90% vs. 33.8%, p=0.0001). However mortality was very low, only 5% probably because of early diagnosis and treatment of patients at risk for bacterial meningitis but neurologic sequellea were significantly more common (p=0.00001) in patients after craniocerebral trauma.

We investigated regularly swabs of adults dispenzarised at Mary Immaculate Clinic of Trnava University in Nairobi providing free health care for about 50 000 population of Mukuru Slums. 20 patients who were treated for AIDS by our clinic (those who started HAART before Free National AIDS Cooperation Programme - NASCOP) were assessed after 1, 2 and 3 years (18 of 20 completed the survey, other 2 loss of follow up, probably died. Exposure to other molecules can select resistant mutants. Previous exposure to TMP/SMX was similar in both groups and therefore was not responsible for the difference between resistance patterns.

Despite of 10 years vaccination of all children within 1st year in Slovakia against H. influenzae, this severe infection still occurs. Among 201 cases of community acquired bacterial meningitis, 14 (7%) were caused by H. influenzae serotype B. Outcome however, after early institution of treatment was fortunately positive - only 1 patient died (7.1% mortality) and in 2 other neurologic sequellae occurred (14.3%), which were transient and mild.

The aim of this study was to assess if differences in etiology and risk factors among 372 cases of bacterial meningitis acquired after surgery (PM) or in community (CBM) have impact on outcome of infected patients. Among 372 cases of bacterial meningitis within last 17 years from 10 major Slovak hospitals, 171 were PM and 201 CBM. Etiology, risk factors such as underlying disease, cancer, diabetes alcoholism, surgery, VLBW, ENT infections, trauma, sepsis were recorded and mortality, survival with sequellae, therapy failure were compared in both groups. Significant differences in etiology and risk factors between both groups were reported. Those after neurosurgery had more frequently Coagulase negative staphylococci (p<0.001), Enterobacteriaceae (p=0.01) and Acinetobacter baumannii (p=0.0008) isolated from CSF and vice versa Streptococcus pneumoniae (p<0.001), Neisseria meningitis (p<0.001) and Haemophillus influenza (p=0.0009) were more commonly isolated from CSF in CBM. Neurosurgery (p<0.001), sepsis (p=0.006), VLBW neonates (p=0.00002) and cancer (p=0.0007) were more common in PM and alcohol abuse (p<0.001) as well as otitis/sinusitis (p<0.001) and Roma ethnic group (p=0.001) in CAM. Initial treatment success was significantly more frequently observed among CAM (p<0.001) but cure after modification was more common in PM (p=0.002). Therefore outcome in both groups was similar (14.6% vs. 12.4%, p=NS).

Listeria monocytogenes is not a rare pathogen causing meningitis, mainly in small children and in close contacts to livestock. The pathogen is naturally resistant to cephalosporins and some glycopeptides as well, therefore despite of syndromologic diagnosis of meningitis and initial therapy with 3rd generation cephalosporins according to the guidelines therapeutic failures with clinical consequences may occur.

The aim of this study was to assess mortality and sequellae within cases from Nationwide survey of community acquired meningitis and identify risk factors for inferior outcome. Risk factors such as underlying disease (diabetes mellitus, cancer, trauma, neonatal age, splenectomy, alcoholism, sepsis, other infections), etiology, clinical symptoms and outcome (death, improvement and cured after modifications of ATB therapy, cured without change of therapy, cured with neurologic sequellae) were recorded and analysed with univariate analysis (chi2 or t test for trends, CDC Atlanta 2004). Analysing risk factors for inferior outcome (death or cured with neurologic sequellae), we compared patients who died or survived with neurologic sequellae to all patients with community acquired bacterial meningitis. Univariate analysis showed that trauma (p<0.05), alcohol abuse (p<0.05), diabetes, S. aureus (p<0.05) and gram-negative etiology (A. baumannii, Ps. aeruginosa or Enterobacteriaceae) (36% vs. 11,9%, p<0.05) were predicting inferior outcome. Analysing risk factors for treatment failure (death or failed but cured after change of antibiotic treatment) prior sepsis (34.1% vs. 13.9%, p<0.01) and gram-negative etiology (25% vs. 11.9%, p<0.02) were statistically significant predictors of treatment failure. Neisseria meningitis had less failures (p<0.05). Concerning infection associated mortality again diabetes mellitus (p<0.05), alcoholism (p<0.05) staphylococcal and gram-negative etiology (p<0.05) were significant predictors of death. N. meningitis had surprisingly less treatment failures (appropriate and rapid initial therapy). Neurologic sequellae were more common in patients with alcohol abuse (p<0.05), craniocerbral trauma (p<0.05) and less common in meningitis with pneumococcal etiology (p<0.05).

The aim of this short note is to assess gram-negative bacillary community acquired meningitis (CBM) and nosocomial meningitis (NM) within 17 years nationwide survey. All cases of gram-negative bacillary CBM within 1990-2007 were assessed in national database of 372 patients with bacterial meningitis: 69 of gram-negative cases were nosocomial and 24 of gram-negative meningitis cases were CBM. Those 24 cases were compared with all CBM (201 cases) for risk factors and outcome. Among nosocomial gram-negative pathogens, A. baumannii in 23 cases, Ps. aeruginosa in 15 cases and Enterobacteriaceae in 31 cases were isolated. Among CBM, in 13 cases Enterobacteriaceae (Escherichia coli 6, Klebsiella pneumoniae 3, Proteus mirabilis 2, Enterobacter cloacae 2), in 5 cases Ps. aeruginosa and in 6 cases Acinetobacter baumannii were isolated from cerebrospinal fluid (CSF). The only significant risk factor for CBM due to gram-negative bacilli was neonatal age (12.5% vs. 3.5%, p=0.04) as underlying disease. However, mortality among gram-negative bacillary meningitis was significantly higher (12.4% vs. 37.5%, p=0.001) in comparison to other meningitis.

Immunodeficiency with reduced clearance of respiratory pathogens, multiple courses of antibiotic therapy in consequence of opportunistic infections and long-term rifampin therapy for tuberculosis (TB) and cotrimoxazol chemoprophylaxis have been associated with antibiotic resistance in HIV positive patient population. 1 Docze A. Benca G. Augustin A. Beno P. Babela O. Krcmery Jr., V. Is antimicrobial multiresistance to antibiotics in Cambodian HIV positive children related to prior antiretroviral or tuberculosis chemotherapy?. Scand J Infect Dis. 2004; 36 ([Letter]): 779-780 PubMed Google Scholar