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Campylobacter is one of the main causative agents of bacterial gastrointestinal infections. Recently, a rise in the incidence of campylobacteriosis has been reported worldwide. Despite the clinical importance of this zoonotic disease, its microbiological diagnosis is not systematically performed in clinical laboratories in developing countries such as the Middle East and North Africa region. Multidrug-resistant Campylobacter isolates, particularly against erythromycin and ciprofloxacin, have been highly reported. The findings of this study highlight the critical need to urge clinical laboratories in the Middle East and North Africa region to include screening for Campylobacter in the routine stool culture of diarrheal patients. Although there is a paucity of data regarding the epidemiology of human campylobacteriosis, alarming rates of infection prevalence and antimicrobial resistance were found in Egypt, Iran, Qatar and Lebanon.

Antibiotic misuse in the animal sector is the first cause of the emergence and spreading of MDR bacteria. Prevention of infectious diseases and enhancement of animal growth are the main effects of antibiotics that push farmers and veterinarians to use this molecule in animal farms. Thus, the use of alternative solutions such as natural antimicrobial substances as well as probiotic strains is a crucial need in this sector. Enterococcus faecium CMUL1216 was isolated from healthy human baby's feces. This strain was assessed in vitro for probiotic properties including activity against many pathogens isolated from animal, human, and soil samples. CMUL1216 strain exhibits good antimicrobial activity against indicator pathogens in both planktonic and biofilm forms. In addition, CMUL1216 strain showed a strong biofilm formation. Furthermore, CMUL1216 exhibits a good anti-inflammatory effect by inducing the secretion of IL-10 in vitro. Moreover, this strain did not show any pathogenic characteristics such as hemolytic effect, presence of virulence genes as well as susceptibility to the majority of antibiotic families. E. faecium CMUL1216 could be a good candidate to be used a probiotic strain in the animal sector in order to maintain animal health and therefore reduce antibiotic resistance caused by the excessive use in this sector.

Objective The association between diabetes mellitus and tuberculosis is a health-threatening double trouble. Vulnerable populations such as refugees and conflict-displaced populations may be at higher risk of both diseases. Here, we examined the prevalence of latent tuberculosis infection (LTBI) and its associated risk factors in a population of Syrian refugees with diabetes in North Lebanon. Study design This is a cross-sectional study. Methods A total of 87 Syrian refugees with diabetes were enrolled. Demographic and clinical data were collected using a structured questionnaire, and a blood sample was obtained from each patient. LTBI was examined using the last generation QuantiFERON-TB Gold Plus assay. Results The mean age of the study population was 54.1 ± 10.5 years, and the majority were women (79.3%). LTBI was found in 1 in 5 (17/87; 19.5%) enrolled patients, with the majority being originated from Aleppo (47.05%). Infection was significantly associated only with age (P = 0.009), and its risk was 4-fold higher in patients aged ≥60 years (odds ratio: 4.1, confidence interval: 1.4–12.5, P = 0.018). Conclusion This study highlights the need to implement effective tuberculosis control strategies among refugees with diabetes, with particular attention to those at older age.

This study aimed to evaluate the routine identification tools available in Lebanon for differentiation of Escherichia coli and Shigella spp. The identification of 43 isolates defined as Shigella spp. by Api 20E was accessed using MALDI-TOF, serological testing, duplex PCR targeting ipaH (present in Shigella spp. and enteroinvasive E. coli “EIEC”) and lacY (found in E. coli including EIEC but not Shigella spp.) as well as gyrB gene sequencing. Antibiotic susceptibility was investigated as well as Shiga-toxin production. All isolates were identified as E. coli by MALDI-TOF while the PCR showed a disparate group of 26 EIEC, 11 Shigella spp., 5 E. coli and 1 inactive E. coli. However, the sequencing of gyrB gene, which was recently described as a suitable marker for distinguishing E. coli and Shigella spp., identified all isolates as E. coli. Antibiotic resistance was noticeable against ß-lactams, rifampicin, trimethoprim-sulfamethoxazole, gentamicin, and ciprofloxacin. The most common variants of beta-lactamase genes were blaTEM-1, blaCTX-M-15, and blaCTX-M-3. A great discordance between the used methods in identification was revealed herein. An accurate identification technique able to distinguish E. coli from Shigella spp. in routine laboratories is a pressing need in order to select the appropriate treatment and assess the epidemiology of these bacteria.

Hepatitis E virus is the main cause of acute hepatitis globally. Infection is especially serious in pregnant women in whom the death rate can reach 25%. The prevalence of hepatitis E virus in pregnant women in Lebanon is not known.This study aimed to investigate the seroprevalence of hepatitis E virus infection in a sample of pregnant women in northern Lebanon.A total of 450 pregnant women from Tripoli, North Lebanon were enrolled in the study. Sera were tested for the presence of anti-hepatitis E virus IgG antibodies using an ELISA technique. Information was collected on the sociodemographic characteristics of the women and their risk factors for hepatitis E virus infection (drinking-water source, blood transfusion and contact with animals).Only one woman was positive for hepatitis E virus giving a prevalence of 0.22%. She had good living conditions, socioeconomic status and educational level and reported no exposure to any risk factors associated with hepatitis E virus infection. Most of the women (87.3%) had a medium or high income level, 47.1% had a university education and 64.9% drank bottled water. Only a small proportion were exposed to risk factors for hepatitis E virus infection: 14.7% had direct contact with animals and 3.8% had had a blood transfusion.The prevalence of hepatitis E virus infection in the sample was low (0.22%). However, further epidemiological studies among other population groups are required to determine the national prevalence of hepatitis E virus in Lebanon.الانتشار المصليّ لفيروس التهاب الكبد E بين الحوامل في شمال لبنان.محمد بشار إسماعيل، صفاء خضر، مروان عثمان، حسان ملاط ، فؤاد دبوسي، منذر حمزة.فيروس التهاب الكبد E هو السبب الرئيسي لالتهاب الكبد الحاد على مستوى العالم. وتكون العدوى به خطيرة خصوصاً بالنسبة للحوامل اللاتي قد يصل معدل الوفيات بينهن إلى %25. وليس معروفاً سبب انتشار التهاب الكبد E بين الحوامل في لبنان.هدفت هذه الدراسة إلى استقصاء أسباب الانتشار المصلي للعدوى بفيروس التهاب الكبد E في عينة من الحوامل في شمال لبنان.بلغ مجموع الحوامل اللاتي شملتهن هذه الدراسة 450 سيدةً من طرابلس، شمال لبنان. وقد فُحصت الأمصال للتحقق من وجود الأجسام المضادة من مجموعة الجلوبيولين المناعي IgG لفيروس التهاب الكبد E باستخدام مقايسة المُمْتز المناعي المرتبط بالإنزيم. وجُعت معلومات حول الخصائص الاجتماعية السكانية للنساء، وعوامل الخطر المرتبطة بتعرضهن للإصابة بعدوى فيروس التهاب الكبد E (مصدر مياه الشرب، ونقل الدم، ومخالطة الحيوانات).تبين إصابة امرأة واحدة فقط بفيروس التهاب الكبد E، مما يمثل الانتشار بنسبة %0.22 فقط. وتتمتع هذه السيدة بظروف معيشية جيدة، ووضع اجتماعي واقتصادي جيد، ومستوى تعليمي جيد، وأفادت بعدم تعرضها لأي من عوامل الخطر المرتبطة بالعدوى بفيروس التهاب الكبد E. وكان مستوى الدخل لمعظم النساء اللاتي شملتهن الدراسة (%87.3) متوسطاً أو مرتفعاً؛ و%47.1 منهن حاصلات على شهادة جامعية؛ و%64.9 منهن يشربن الماء المعبّأ في قوارير. وتعرضت نسبة ضئيلة منهن فقط لعوامل خطر الإصابة بعدوى فيروس التهاب الكبد E : منهن %14.7 خالطن الحيوانات بشكلٍ مباشر؛ و%3.8 خضعن لعملية نقل دم.كان معدل انتشار العدوى بفيروس التهاب الكبد E منخفضا في العينة (%0.22). ولكن يلزم إجراء مزيدٍ من الدراسات الوبائية على مستوى الفئات السكانية الأخرى لتحديد انتشار فيروس التهاب الكبد E على المستوى الوطني في لبنان.Séroprévalence du virus de l'hépatite E chez les femmes enceintes au nord du Liban.Le virus de l’hépatite E constitue la principale cause d’hépatite aiguë dans le monde. L’infection est particulièrement grave pour les femmes enceintes, chez qui le taux de mortalité peut atteindre 25 %. La prévalence du virus de l’hépatite E chez les femmes enceintes au Liban n’est pas connue.La présente étude visait à étudier la séroprévalence de l’infection par le virus de l’hépatite E dans un échantillon de femmes enceintes au nord du Liban.Au total, 450 femmes enceintes de Tripoli, dans le nord du Liban, ont été incluses dans l’étude. Des prélèvements sériques ont été effectués à la recherche d’anticorps de la classe des IgG dirigés contre le virus de l’hépatite E en recourant à la méthode ELISA. Des informations ont été recueillies sur les caractéristiques sociodémographiques de ces femmes et leurs facteurs de risque d’infection par le virus de l’hépatite E (source d’eau de boisson, transfusion sanguine et contact avec les animaux).Une seule femme a été testée positive au virus de l’hépatite E, pour une prévalence de 0,22 %. Ses conditions de vie, son statut socio-économique et son niveau d’études étaient bons, et elle n’avait indiqué aucune exposition à aucun facteur de risque associé à l’infection par le virus de l’hépatite E. La plupart des femmes (87,3 %) avaient un niveau de revenu moyen à élevé, 47,1 % d’entre elles avaient reçues une formation universitaire et 64,9 % buvaient de l’eau en bouteille. Seule une faible proportion d’entre elles étaient exposées à des facteurs de risque d’infection par le virus de l’hépatite E : 14,7 % d’entre elles avaient un contact direct avec des animaux et 3,8 % avaient reçu une transfusion sanguine.La prévalence de l’infection par le virus de l’hépatite E dans l’échantillon était faible (0,22 %). Cependant, d’autres études épidémiologiques au sein d’autres groupes de population sont nécessaires pour déterminer la prévalence du virus de l’hépatite E à l’échelle nationale au Liban.

Background and Objectives: Due to their weakened immune response, hemodialysis (HD) patients with latent tuberculosis infection (LTBI) are at higher risk for active tuberculosis (TB) disease and are more subject to patient-to-patient transmission within dialysis units. Consequently, current guidelines advocate screening these patients for LTBI. To our knowledge, the epidemiology of LTBI in HD patients has never been examined before in Lebanon. In this context, this study aimed to determine LTBI prevalence among patients undergoing regular HD in Northern Lebanon and to identify potential factors associated with this infection. Notably, the study was conducted during the COVID-19 pandemic, which is likely to have catastrophic effects on TB and increase the risk of mortality and hospitalization in HD patients. Materials and Methods: A multicenter cross-sectional study was carried out in three hospital dialysis units in Tripoli, North Lebanon. Blood samples and sociodemographic and clinical data were collected from 93 HD patients. To screen for LTBI, all patient samples underwent the fourth-generation QuantiFERON-TB Gold Plus assay (QFT-Plus). Multivariable logistic regression analysis was used to identify the predictors of LTBI status in HD patients. Results: Overall, 51 men and 42 women were enrolled. The mean age of the study population was 58.3 ± 12.4 years. Nine HD patients had indeterminate QFT-Plus results and were therefore excluded from subsequent statistical analysis. Among the remaining 84 participants with valid results, QFT-Plus was positive in 16 patients, showing a positivity prevalence of 19% (95% interval for p: 11.3%, 29.1%). Multivariable logistic regression analysis showed that LTBI was significantly associated with age [OR = 1.06; 95% CI = 1.01 to 1.13; p = 0.03] and a low-income level [OR = 9.29; 95% CI = 1.62 to 178; p = 0.04]. Conclusion: LTBI was found to be prevalent in one in five HD patients examined in our study. Therefore, effective TB control measures need to be implemented in this vulnerable population, with special attention to elderly patients with low socioeconomic status.

Background There is little information on the epidemiology of enteric pathogens in Lebanon, a low- and middle-income country that suffers from a myriad of public health challenges. To address this knowledge gap, we aimed to assess the prevalence of enteric pathogens, identify risk factors and seasonal variations, and describe associations between pathogens among diarrheic patients in the Lebanese community. Methodology and principal findings A multicenter cross-sectional community-based study was conducted in the north of Lebanon. Stool samples were collected from 360 outpatients suffering from acute diarrhea. Based on fecal examination using the BioFire® FilmArray® Gastrointestinal Panel assay, the overall prevalence of enteric infections was 86.1%. Enteroaggregative Escherichia coli (EAEC) was the most frequently identified (41.7%), followed by enteropathogenic E. coli (EPEC) (40.8%) and rotavirus A (27.5%). Notably, two cases of Vibrio cholerae were identified, while Cryptosporidium spp. (6.9%) was the most common parasitic agent. Overall, 27.7% (86/310) of the cases were single infections, and the majority, 73.3% (224/310), were mixed infections. Multivariable logistic regression models showed that enterotoxigenic E. coli (ETEC) and rotavirus A infections were significantly more likely to occur in the fall and winter compared to the summer. Rotavirus A infections significantly decreased with age but increased in patients living in rural areas or suffering from vomiting. We identified strong associations in the co-occurrence of EAEC, EPEC, and ETEC infections and a higher percentage of rotavirus A and norovirus GI/GII infections among EAEC-positive cases. Conclusions Several of the enteric pathogens reported in this study are not routinely tested in Lebanese clinical laboratories. However, anecdotal evidence suggests that diarrheal diseases are on the rise due to widespread pollution and the deterioration of the economy. Therefore, this study is of paramount importance to identify circulating etiologic agents and prioritize dwindling resources to control them and limit outbreaks in the future.

Dermatophytosis corresponds to a broad series of infections, mostly superficial, caused by a group of keratinophilic and keratinolytic filamentous fungi called dermatophytes. These mycoses are currently considered to be a major public health concern worldwide, particularly in developing countries such as those in the Middle East and North Africa (MENA) region. Here we compiled and discussed existing epidemiologic data on these infections in the MENA region. Most of the available studies were based on conventional diagnostic strategies and were published before the last taxonomic revision of dermatophytes. This has led to misidentifications, which might have resulted in the underestimation of the real burden of these infections in the MENA countries. Our analysis of the available literature highlights an urgent need for further studies based on reliable diagnostic tools and standard susceptibility testing methods for dermatophytosis, which represents a major challenge for these countries. This is crucial for guiding appropriate interventions and activating antifungal stewardship programs in the future.

The outstanding ability of Acinetobacter baumannii to cause outbreaks and acquire multidrug resistance motivated the development of a plethora of typing techniques, which can help infection preventionists and hospital epidemiologists to more efficiently implement intervention controls. Nowadays, the world is witnessing a gradual transition from traditional typing methodology to whole genome sequencing-based approaches. Such approaches are opening new prospects and applications never achieved by existing typing methods. Herein, we provide the reader with an updated review on A. baumannii typing methods recapping the added value of well-established techniques previously applied for A. baumannii and detailing new ones (as clustered regularly interspaced short palindromic repeats-based typing) with a special focus on whole genome sequencing.

1. The real burden of Campylobacter spp. in Lebanon is still unknown. The aims of this study were to unravel the epidemiology of Campylobacter spp. in broilers at slaughterhouses in Tripoli, North of Lebanon and to characterise their antibiotic resistance profiles.2. From May to November 2015, sampling was performed through five repeated surveys from 15 slaughterhouses that sold chicken directly to Lebanese customers. Isolates were subjected to pulsed field gel electrophoresis (PFGE) and flaA-restriction fragment length polymorphism (flaA-RFLP).3. All investigated slaughterhouses were found to be positive for Campylobacter spp. Campylobacter coli was the predominant species (38 isolates) followed by C. jejuni (eight isolates). A noticeable level of resistance was detected among isolates against ciprofloxacin (97% of C. coli and 87.5% of C. jejuni), amoxicillin (89% of C. coli and 75% of C. jejuni), gentamicin (79% of C. coli and 50% of C. jejuni), and co-amoxiclav (24% of C. coli and 25% of C. jejuni). Erythromycin and ertapenem resistance were observed only in C. coli with the following percentages 74% and 13% respectively, but not in C. jejuni. PFGE and flaA-RFLP using DdeI as restriction enzyme divided the strains into 27 and 25 types respectively.4. The high observed genetic diversity of Campylobacter spp. revealed the complexity of the spread of this genus in broilers. This study highlighted the pressing need to monitor antibiotic resistance and to ensure food safety from 'farm to fork' in Lebanon.

Antibiotics can truly be considered the symbol of the 20th century's miracle drugs. However, excessive and inappropriate use of antibiotics in human and veterinary medicine has led to repercussions in terms of mortality, morbidity, and financial and societal costs, especially with the lack of novel drugs to combat infections caused by antimicrobial-resistant pathogens. Unfortunately, antimicrobial resistance (AMR) has increased significantly worldwide in the past decades, particularly in developing third-world countries. Hence, various key organisations have made AMR the focus of highly visible reports, conferences and actions. Nevertheless, the majority of investigations were initiated in the developed world. In Lebanon, as in other developing countries, AMR remains responsible for significant morbidity and mortality. Whilst a large number of studies have targeted the AMR crisis in Lebanese clinical settings, its epidemiological situation in animals, foodstuffs and the environment is still unclear in this country. In this context, and in order to better survey, control and prevent the emergence of multidrug-resistant bacterial strains in Lebanese non-clinical settings, this work reviewed the available data on the epidemiology of antimicrobial-resistant bacteria isolated from Lebanese extra-hospital sources.

Antibiotic resistance (ABR) is a major global health threat that increases the risk of treatment failure and increases medical costs. One of the most common factors contributing to the spread of ABR is self-medication. The public, as well as workers in clinical and veterinary sectors, commit false practices towards appropriate antibiotic use, favouring the spread of resistance. As such, the first Lebanese Antibiotic Awareness Week campaign was initiated with a human-centred and interactive approach. The data showed a strikingly low level of antibiotic awareness. Cooperation between relevant stakeholders, policy-makers and health actors is crucial to control and overcome the problem of ABR.

The laboratory surveillance of bacillary dysentery is based on a standardised Shigella typing scheme that classifies Shigella strains into four serogroups and more than 50 serotypes on the basis of biochemical tests and lipopolysaccharide O-antigen serotyping. Real-time genomic surveillance of Shigella infections has been implemented in several countries, but without the use of a standardised typing scheme. We studied over 4,000 reference strains and clinical isolates of Shigella, covering all serotypes, with both the current serotyping scheme and the standardised EnteroBase core-genome multilocus sequence typing scheme (cgMLST). The Shigella genomes were grouped into eight phylogenetically distinct clusters, within the E. coli species. The cgMLST hierarchical clustering (HC) analysis at different levels of resolution (HC2000 to HC400) recognised the natural groupings for Shigella. By contrast, the serotyping scheme was affected by horizontal gene transfer, leading to a conflation of genetically unrelated Shigella strains and a separation of genetically related strains. The use of this cgMLST scheme will enhance the laboratory surveillance of Shigella infections.

Antibiotic misuse in the animal sector is the first cause of the emergence and spreading of MDR bacteria. Prevention of infectious diseases and enhancement of animal growth are the main effects of antibiotics that push farmers and veterinarians to use this molecule in animal farms. Thus, the use of alternative solutions such as natural antimicrobial substances as well as probiotic strains is a crucial need in this sector. Enterococcus faecium CMUL1216 was isolated from healthy human baby's feces. This strain was assessed in vitro for probiotic properties including activity against many pathogens isolated from animal, human, and soil samples. CMUL1216 strain exhibits good antimicrobial activity against indicator pathogens in both planktonic and biofilm forms. In addition, CMUL1216 strain showed a strong biofilm formation. Furthermore, CMUL1216 exhibits a good anti-inflammatory effect by inducing the secretion of IL-10 in vitro. Moreover, this strain did not show any pathogenic characteristics such as hemolytic effect, presence of virulence genes as well as susceptibility to the majority of antibiotic families. E. faecium CMUL1216 could be a good candidate to be used a probiotic strain in the animal sector in order to maintain animal health and therefore reduce antibiotic resistance caused by the excessive use in this sector.

Pseudomonas aeruginosa is a common cause of healthcare-associated infections and chronic airway diseases in non-clinical settings. P. aeruginosa is intrinsically resistant to a variety of antimicrobials and has the ability to acquire resistance to others, causing increasingly recalcitrant infections and elevating public health concerns. We reviewed the literature on multidrug-resistant (MDR) P. aeruginosa isolated from humans (nosocomial and community-associated), animals, and the environment in Lebanon, a country that has been suffering from a surge in antimicrobial resistance (AMR). We identified 24 studies that described the epidemiology and antimicrobial susceptibility profiles of P. aeruginosa. Our analysis showed that the bacterium was predominant in lesions of patients on mechanical ventilation and in burn patients and those with diabetic foot infections and hematological malignancies. We also found that carbapenem resistance in P. aeruginosa isolates in Lebanon involved both enzymatic and non-enzymatic mechanisms but depended predominantly on VIM-2 production (40.7%). Additionally, MDR P. aeruginosa was detected in animals, where a recent study reported the emergence of carbapenemase-producing P. aeruginosa in livestock in Lebanon. Notably, no studies evaluated the contribution of MDR P. aeruginosa in the environment to human infections. Taken together, our findings highlight the need for AMR surveillance programs and a national action plan to combat resistance in Lebanon.

Watchful epidemiological surveillance of macrolide-resistant Group A Streptococcus (MRGAS) clones is important owing to the evolutionary and epidemiological dynamic of GAS. Meanwhile, data on the global distribution of MRGAS emm types according to macrolide resistance phenotypes and genotypes are scant and need to be updated. For this, the present systematic review analyses a global set of extensively characterized MRGAS isolates from patients of diverse ages and clinical presentations over approximately two decades (2000 to 2020) and recaps the peculiar epidemiological features of the dominant MRGAS clones. Based on the inclusion and exclusion criteria, 53 articles (3593 macrolide-resistant and 15,951 susceptible isolates) distributed over 23 countries were dissected with a predominance of high-income countries over low-income ones. Although macrolide resistance in GAS is highly variable in different countries, its within-GAS distribution seems not to be random. emm pattern E, 13 major emm types (emm12, 4, 28, 77, 75, 11, 22, 92, 58, 60, 94, 63, 114) and 4 emm clusters (A-C4, E1, E6, and E2) were significantly associated with macrolide resistance. emm patterns A-C and D, 14 major emm types (emm89, 3, 6, 2, 44, 82, 87, 118, 5, 49, 81, 59, 227, 78) and 3 well-defined emm clusters (A-C5, E3, and D4) were significantly associated with macrolide susceptibility. Scrutinizing the tendency of each MRGAS emm type to be significantly associated with specific macrolide resistance phenotype or genotype, interesting vignettes are also unveiled. The 30-valent vaccine covers ~95% of MRGAS isolates. The presented data urge the importance of comprehensive nationwide sustained surveillance of MRGAS circulating clones particularly in Low and Middle income countries where sampling bias is high and GAS epidemiology is obfuscated and needs to be demystified.

The Shigella genus includes serious foodborne disease etiologic agents, with 4 species and 54 serotypes. Identification at species and serotype levels is a crucial task in microbiological laboratories. Nevertheless, the genetic similarity between Shigella spp. and Escherichia coli challenges the correct identification and serotyping of Shigella spp., with subsequent negative repercussions on surveillance, epidemiological investigations, and selection of appropriate treatments. For this purpose, multiple techniques have been developed historically ranging from phenotype-based methods and single or multilocus molecular techniques to whole-genome sequencing (WGS). To facilitate the selection of the most relevant method, we herein provide a global overview of historical and emerging identification and serotyping techniques with a particular focus on the WGS-based approaches. This review highlights the excellent discriminatory power of WGS to more accurately elucidate the epidemiology of Shigella spp., disclose novel promising genomic targets for surveillance methods, and validate previous well-established methods.

Aim: To characterize the epidemiology of group A Streptococcus (GAS) involved in nonpharyngeal infections sparingly addressed in Lebanon. Materials & methods: A collection of 63 nonpharyngeal GAS isolates recovered between 2010 and 2019 from northern Lebanon were analyzed through emm typing, virulence gene profiling, FCT typing and antibiotic susceptibility analysis. Results & conclusion: A total of 29 emm subtypes was detected, with emm1 being the most dominant. A great intraclonal divergence driven by the loss and gain of superantigens or by the structural variability within the FCT regions was unraveled. The resistance rates for erythromycin and tetracycline were 8 and 20.6%, respectively. The 30-valent vaccine coverage was 76%. This study evidences the complexity of the neglected GAS pathogen in Lebanon.

While COVID-19 continues to spread across the globe, diligent efforts are made to understand its attributes and dynamics to help develop treatment and prevention measures. The paradox pertaining to children being the least affected by severe illness poses exciting opportunities to investigate potential protective factors. In this paper, we propose that childhood vaccination against pertussis (whooping cough) might play a non-specific protective role against COVID-19 through heterologous adaptive responses in this young population. Pertussis is a vaccine-preventable infectious disease of the respiratory tract and it shares many similarities with COVID-19 including transmission and clinical features. Although pertussis is caused by a bacterium (Bordetella pertussis) while COVID-19 is a viral infection (SARS-CoV-2), previous data showed that cross-reactivity and heterologous adaptive responses can be seen with unrelated agents of highly divergent groups, such as between bacteria and viruses. While we build the arguments of this hypothesis on theoretical and previous empirical evidence, we also outline suggested lines of research from different fields to test its credibility. Besides, we highlight some concerns that may arise when attempting to consider such an approach as a potential public health preventive intervention against COVID-19.

Background and Objectives: Several LAB species were evaluated and characterized for potential probiotic use. Besides the antimicrobial activity, probiotics showed recently a capacity to prevent and to alleviate inflammatory and chronic diseases. Immunomodulation effect is one of the modes of actions of such probiotics, called immunobiotics, which can be used in several chronic diseases such as Inflammatory Bowel Diseases (IBD). The aim of this study was to isolate, identify and char- acterize lactobacilli strains from healthy baby’s feces in order to select some strains with potential immunobiotic application especially strains which can stimulate anti-inflammatory responses. Materials and Methods: Forty-two LAB strains were isolated and identified by the MALDI-TOF / MS technique. In addi- tion, strains were subjected to several assessments such as antimicrobial activity, the capacity to form biofilm in polystyrene microplate and immunomodulation activity in a PBMC model. Results: Results showed that the majority of strains (90.4%) were identified as Lactobacillus. However, among these, only 39.4% of lactobacilli strains were not identified at the species level. All isolated lactobacilli strains showed an anti-inflam- matory effect. Moreover, 7 strains were considered as good probiotic candidates based on their characteristics such as their antibacterial activities, formation of the strongest biofilm and their ability to stimulate an anti-inflammatory response in PBMCs model. Conclusion: Two strains (Lactobacillus spp S14 and Lactobacillus spp S49) which showed the best immunobiotic char- acteristics, could be selected and evaluated more deeply in vivo model as well as in human clinical study to ensure their effectiveness in inflammatory diseases such as IBD.

The aim of the present study was to investigate the potential of bifidobacteria in protecting cells from coxsackievirus B4 (CV-B4) infection. Bifidobacterial screening identified two of five strains that protected human epithelial type 2 (HEp-2) cell viability when bifidobacteria were incubated with viral particles prior to inoculation. In contrast, no effect was shown by incubating HEp-2 cells with bifidobacteria prior to CV-B4 inoculation. Cell wall lipoprotein aggregates (LpAs) secreted by the selected strains were assayed for their antiviral activity. The two LpAs exhibited antiviral activity when they were incubated with viral particles prior to inoculation of HEp-2 cells. Recombinant LpA-derived protein exhibited identical antiviral activity. To identify the peptide sequences interacting with the virus particles, LpA proteins were aligned with the peptide sequences of the north canyon rim and puff footprint onto coxsackievirus and adenovirus receptor (CAR). The in silico molecular docking study using CV-B3 as template showed low-energy binding, indicating a stable system for the selected peptides and consequently a likely binding interaction with CV-B. Bifidobacterium longum and Bifidobacterium breve peptides homologous to the viral north rim footprint onto CAR sequence formed hydrogen bonds with several viral residues in the north rim of the canyon, which were already predicted as interacting with CAR. In conclusion, proteins from bifidobacterial LpAs can inhibit infection with CV-B4, likely through binding to the capsid amino acids that interact with CAR.

Purpose. Streptococcus pneumoniae is a commensal bacterium that normally colonizes the human nasopharyngeal cavity. Once disseminated, it can cause several diseases, ranging from non-invasive infections such as acute otitis media and sinusitis through to invasive infections with higher mortality, including meningitis and septicaemia. Since the identification of the first S. pneumoniae strain with decreased susceptibility to penicillin in the 1960s, antibiotic resistance among S. pneumoniae has increased disturbingly and the mechanisms of resistance have begun to unfold. Methodology. This work briefly reviewed the available data on the molecular mechanisms underlying antimicrobial resistance and its epidemiology among pneumococcal strains in Middle Eastern countries. Key findings. Both intrinsic and acquired mechanisms (mutations, acquisition of novel mobile genetic elements and sometimes gene duplication and overexpression) affect susceptibility to a large variety of antibiotics. In Middle Eastern countries, including Lebanon, Iran, Saudi Arabia and Turkey, surveillance showed a disturbing increase in the strength and prevalence of resistance to antibiotics over the years, especially in the last decade. However, no surveillance reports were found in other Middle Eastern countries, such as Syria and Iraq. Conclusion. In order to better survey, control and prevent the emergence of multidrug- and extremely drug-resistant S. pneumoniae strains, antimicrobial stewardship, national surveillance and public awareness programmes should be developed urgently in Middle Eastern countries.

The outstanding ability of

Quinolones are an important antimicrobial class used widely in the treatment of enterobacterial infections. Although there are multiple mechanisms of quinolone resistance, attention should be paid to plasmid-mediated genes due to their ability to facilitate the spread of quinolone resistance, the selection of mutants with a higher-level of quinolone resistance, and the promotion of treatment failure. Since their discovery in 1998, plasmid-mediated quinolone resistance (PMQR) mechanisms have been reported more frequently worldwide especially with the extensive use of quinolones in humans and animals. Nevertheless, data from the Arab countries are rare and often scattered. Understanding the prevalence and distribution of PMQR is essential to stop the irrational use of quinolone in these countries. This manuscript describes the quinolone resistance mechanisms and particularly PMQR among Enterobacteriaceae as well as their methods of detection. Then the available data on the epidemiology of PMQR in clinical and environmental isolates from the Arab countries are extensively reviewed along with the other associated resistance genes. These data shows a wide dissemination of PMQR genes among Enterobacteriaceae isolates from humans, animals, and environments in these countries with increasing rates over the years and a common association with other antibiotic resistance genes as blaCTX-M-15. The incontrovertible emergence of PMQR in the Arab countries highlights the pressing need for effective stewardship efforts to prevent the selection of a higher rate of quinolone resistance and to preserve these crucial antibiotics.

Introduction: The raw goat milk is considered as a good source of novel bacteriocinogenic lactic acid bacteria (LAB) strains. Method: The bacteriocin, which named enterocin CMUL20-2 was secreted by Enterococcus faecium CMUL20-2. This bacterial strain was originally isolated from raw goat’s milk, was extracted by using a modified adsorption-desorption method and purified via RP-HPLC. antimicrobial activity was tested against several pathogenic and spoilage microbes. Results: The enterocin CMUL20-2 showed a strong adsorption on cell wall of producer strain even in acidic environment which facilitate its extraction in only two simple steps. The recovered purified enterocin has decreased procedure time and diminished the number of undesirable molecules present in Rogosa and Sharpe (MRS) broth. The recovered enterocin showed antimicrobial activity against several foodborne pathogenic and spoilage microbes. Conclusion: The recovered enterocin was able to tolerate a variety of food chain conditions such as high temperature, pH and storage stability, and it can be a good candidate to protect food from spoilage microbes

Background Rapid and accurate techniques are always welcomed for the detection of resistant strains of Mycobacterium tuberculosis MTB. Objectives The objective of this study is to evaluate the pyrosequencing technology for the detection of MTB resistance to Rifampicin (RIF) and Isoniazid (INH) in Syrian and Lebanese clinical strains; 66 strains resistant to INH, among them 56 resistant also to RIF, were tested. Methods Four pyrosequencing assays were optimized and applied to the following loci: rpoB rpoB RIF resistance-determining region, katG , the promoter regions of inhA and ahpC - oxyR intergenic region. Results The prevalence of mutations on codon 315 of the katG gene, inhA and ahpc - oxyR were 42.4%, 21.2% and 9.0%, respectively, which make an overall sensitivity of 72.6% for INH resistance. All RIF-resistant strains contained at least one non-synonymous codon change in the sequenced rpoB region (507–533) relative to the ATCC reference strain. The RIF drug resistance region (RRDR) sequencing identified 96 modified codons representing 34 different mutations. Conclusions The high sensitivity and the short turnaround time combined with multilocus sequencing of several isolates in parallel make pyrosequencing an attractive method for drug resistance screening for MTB .

Emerging β-lactamase-producing-bacteria (ESBL, AmpC and carbapenemases) have become a serious problem in our community due to their startling spread worldwide and their ability to cause infections which are difficult to treat. Diagnosis of these β-lactamases is of clinical and epidemiological interest. Over the past 10 years, several methods have been developed aiming to rapidly detect these emerging enzymes, thus preventing their rapid spread. In this review, we describe the range of screening and detection methods (phenotypic, molecular and other) for detecting these β-lactamases but also whole genome sequencing as a tool for detecting the genes encoding these enzymes.

Acinetobacter baumannii is an opportunistic bacterium involved in several types of infection with high mortality and morbidity, especially in intensive care units. Treatment of these infections remains a challenge due to the worldwide emergence of broad-spectrum resistance to many antibiotics. Following the implementation of molecular techniques to study A. baumannii outbreaks, it has been shown that they are mainly caused by specific clones such as international clones I, II and III. The present work aims to review the available data on the mechanisms underlying antimicrobial resistance in A. baumannii, with a special focus on the molecular epidemiology of this species in Lebanon.

The emergence and spread of carbapenem-resistant bacteria are a significant clinical and public health concern. The aim of the study is to determine the prevalence of intestinal carriage of carbapenem-resistant bacteria and yeasts in cancer patients under chemotherapy. 41 stool samples collected from cancer patients in Nini hospital in Tripoli, North Lebanon have been analyzed. After isolating yeasts and carbapenem-resistant bacteria, a biochemical identification and antimicrobial susceptibility profile were determined. The mechanism of enzymatic carbapenem-resistance was detected by searching for carbapenemases by both Hodge test and PCR assays. The association of several mechanisms of resistance was also searched. 46.3% (19/41) of patients were colonized by yeast. Candida glabrata (6/19) was the major species. The prevalence of carbapenem-resistant bacteria was 24.4% (10/41) including Escherichia coli (5/10), Enterobacter cloacae (1/10), Enterobacter aerogenes (1/10) Edwardsiella hoshinae (1/10) Pantoea agglomerans (1/10) and Pseudomonas stutzeri (1/10). PCR and sequencing of the amplified fragments revealed that Pseudomonas stutzeri (1/1) carried VIM gene and Enterobacter aerogenes (1/1) and E. coli (1/5) carried OXA-48 gene. The other Enterobacteriaceae were resistant to carbapenems by mechanisms other than a carbapenemase including hyperproduction of cephalosporinase (4/10), extended spectrum beta-lactamases (1/10) and both cephalosporinase and extended spectrum beta-lactamases (2/10). High prevalence of intestinal carriage of carbapenem-resistant bacteria and yeasts were detected in cancer patients under chemotherapy. In order to prevent the development of endogenous infection and the dissemination of antimicrobial resistance, an implementation of antibiotic stewardship programs and infection control measures is required in hospitals particularly in the department of chemotherapy. Keywords: Cancer, Yeasts, Carbapenemases, Multidrug resistant bacteria, Colonization

Aim We studied 68 ESBL-producing Klebsiella pneumoniae strains isolated in Lebanon, determined their profile of resistance to antibiotics, and identified 6 ESBL genes. Methodology The susceptibility to antibiotics was determined by the disk diffusion method. The MIC of carbapenems and cefepime was determined by the agar dilution method. ESBL genes were detected by PCR. Results A percentage of 88.2% and 86.7% of isolates carried the SHV and CTX-M gene respectively; combinations of more than 1 gene of resistance were detected in several isolates. Five strains were resistant to carbapenems; 4/5 carried the OXA-48 gene. Conclusion Our study revealed the emergence of K. pneumoniae ESBL (+) strains carrying several types of genes involved in this phenotype; we also identified carbapenem-resistant strains due to the OXA-48 gene, which are a real threat for public health, especially in Lebanon.

Tetanus is a serious illness that kills about one million people a year globally. This study aimed to i) evaluate immunity against tetanus (by antibodies titres in blood) among health staff and students at the Public Health Faculty, Lebanese University, ii) explore the determinants of the anti-tetanus immunity by a questionnaire and iii) estimate anti-tetanic serum use in the emergency departments of two hospitals (1 private, 1 public) in Tripoli. Most of the participants (76.6%) had anti-tetanus antibody titres ≥ 0.1 UI/mL. There was no association between immune status and gender (P = 0.614) but more participants ≤ 25 years were immunized than those25 years (P0.001) and more students were immunized than employees (P = 0.032). There was an inverse association between anti-tetanus immunity and having visited a physician in the past year (P = 0.009). In 2011, 1037 people received anti-tetanus immunoglobulins at the hospitals, 73% at the private hospital. Vaccination campaigns targetting adults25 years may be warranted to assure good anti-tetanus protection and avoid administration of anti-tetanus immunoglobulins in emergency departments.المناعة ضد الكزاز بين طلاب الجامعات وموظفي الصحة في شمال لبنان وإعطاءُ الأمصال المضادة للكزاز في مستشفيينمنذر حمزة، سني حليس، فؤاد دبوسي، حسان ملاطالكزاز مرض خطير يقتل حوالي مليون شخص سنوياً على مستوى العالم. وقد هدفت هذه الدراسة إلى: أ) تقييم المناعة ضد الكزاز (عن طريق عيارات الأضداد في الدم) لدى الكوادر الصحية وطاب كلية الصحة العامة في الجامعة اللبنانية. ب) استكشاف محدِّدات المناعة ضد الكزاز عن طريق استبيان. ج) تقييم استخدام المصل المضاد للكزاز في أقسام الطوارئ في مستشفيين (أحدهما خاص، والآخر عام) في طرابلس بشمال لبنان. وفي معظم المشاركين (7.66%) كانت عيارات أضداد الكزاز لديهم ≤0.1 وحدة دولية/ مل. ولم يكن هناك ارتباط بين الحالة المناعية والجنس (Immunité antitétanique chez des étudiants universitaires et personnels de santé au Liban-Nord et administration de sérum antitétanique dans deux hôpitaux.Le tétanos est une maladie grave qui tue environ un million de personnes par an dans le monde. Cette étude avait pour but i) d'évaluer le statut immunitaire contre le tétanos (par dosage des anticorps dans le sang) chez le personnel de santé et les étudiants de la Faculté de Santé publique de l’Université Libanaise, ii) d'explorer les déterminants de l'immunité antitétanique grâce à un questionnaire et iii) d'estimer l’utilisation de sérum antitétanique dans les services des urgences de deux hôpitaux (l’un privé, l’autre public) à Tripoli. La majorité des participants à l’étude (76,6 %) avaient un taux d'anticorps antitétaniques supérieur ou égal à 0,1UI/mL. Il n’y avait pas d'association entre le statut immunitaire et le sexe (p = 0,614) mais les plus jeunes (≤ 25 ans) étaient plus immunisés que les plus âgés (25 ans) (p0,001) ; les étudiants étaient plus immunisés que les employés (p = 0,032). Il y avait une association inverse entre l'immunité antitétanique et le fait d'avoir consulté un médecin durant l’année écoulée (p = 0,009). En 2011, 1037 personnes ont reçu des immunoglobulines antitétaniques à l’hôpital, dont 73 % à l’hôpital privé. Des campagnes de vaccination visant les adultes de plus de 25 ans peuvent être proposées pour assurer une bonne protection antitétanique et éviter l'administration d'immunoglobulines antitétaniques aux services des urgences.

ABSTRACT The emergence of Acinetobacter baumannii during recent decades as an important nosocomial pathogen responsible of worldwide, intensively documented, outbreaks has resulted in a need for effective epidemiological typing methods. Throughout the years, many typing methods for A. baumannii epidemiological studies have been proposed from phenotypic to molecular methods. Currently, the use of phenotypic typing methods have declined considerably and been progressively replaced by molecular methods. In this review, we introduce the current molecular methods available for A. baumannii typing. Each method has its own advantages and disadvantages, and the selection of an appropriate genotyping method depends on studied objectives. This review sheds light on questions in different epidemiological settings and most molecular methods used to fit these objectives.

We report here the emergence of VIM-2 and IMP-15 carbapenemases in a series of clinical isolates of carbapenem-resistant Pseudomonas aeruginosa in Lebanon. We also describe the disruption of the oprD gene by either mutations or insertion sequence (IS) elements ISPa 1328 and ISPre 2 isoform. Our study reemphasizes a rapid dissemination of the VIM-2 carbapenemase-encoding gene in clinical isolates of P. aeruginosa in the Mediterranean basin.

Objectives The aim of our study was to confirm the identification of 113 meticillin-resistant Staphylococcus aureus (MRSA) strains by pyrosequencing, to determine the susceptibility of these clinical isolates to various classes of antibiotics, to determine the minimum inhibitory concentration (MIC) to glycopeptides, and to detect mecA and luk-PV genes. Methodology The Staphylococcus species was identified by pyrosequencing of the variable region (V3) of the 16SrRNA. The susceptibility of these 113 strains of MRSA to antibiotics was determined by the disk diffusion method on Mueller-Hinton agar. The MIC of glycopeptides was determined by using the dilution method on solid media. mecA gene and luk-PV gene were detected by PCR. Results The disk diffusion method proved full susceptibility to vancomycin, teicoplanin, and linezolid; whereas MIC (dilution method) indicated that 5/113 strains were resistant to teicoplanin, giving a probability of having heterogeneous glycopeptide intermediate S. aureus (hGISA) strains. The mecA gene was detected in all MRSA strains ruling out the probability of having new variants of this gene in the tested strains. The luk-PV gene was detected in 28 out of 113 MRSA strains (24.8%). Conclusion The originality of this study was the detection of hGISA strains knowing that they were susceptible to glycopeptides according to the diffusion method. Thus it is necessary to check the level of susceptibility of MRSA clinical isolates to glycopeptides for immunodeficient patients, by determining the MIC.

Resistance of Streptococcus pneumoniae to fluoroquinolones arises by stepwise accumulation of spontaneous point mutations in the quinolone-resistance determining regions (QRDRs). Fluoroquinolones treatment of infections caused by first-step mutants (pre-resistant) can lead to the selection of resistant isolates, resulting in treatment failure. First-step mutants cannot however be reliably detected by routine resistance testing. Levofloxacin has been used as a surrogate marker to predict fluoroquinolone susceptibility in clinical laboratories. By use of a PCR followed by pyrosequencing, we examined 45 levofloxacin-susceptible pneumococcal strains [minimal inhibitory concentration (MIC)0.5 μg/ml] for first-step parC and parE mutations in the QRDR: 51.2% of isolates were recovered from pulmonary and nasal secretions, 22.2% from blood, 24.4% from ear and eye discharge, and 2.2% from cerebrospinal fluid. The results showed that three strains (6.6%) had first-step parC (Asp83-Asn) or parE (Asp435-Asn) mutations. This test could be useful for some high-risk patients or in national surveys.

Objectives We investigated the prevalence and the risk factors of nasal carriage of Staphylococcus aureus carrying Panton-Valentine leukocidin genes [ Sa PVL(+)] in pupils. Study population and methods Two hundred and fifty-seven pupils were screened by nasal swabbing. The detection of 16S rRNA , mecA and luk-PV genes was performed by PCR and the risk factors were assessed with the statistical analysis of a questionnaire. Results Thirty-one percent of pupils were colonized, with 16.4% of isolates carrying the luk-PV gene and 8.8% the mecA gene. Children aged 7 years or more and living in a boarding school were the factors promoting nasal carriage 60% of children who presented with an abscess in the previous year were carriers of luk-PV gene Sa . Conclusion The study revealed a high prevalence of luk-PV gene among methicillin-susceptible strains and a statistically significant correlation between the presence of this gene and presenting with an abscess.

Objectives Bacteria multiresistant to antibiotics are widely supposed to be weakly virulent. However, the virulence traits of carbapenem-resistant Enterobacteriaceae have not been investigated. In this work, we investigated the virulence and resistance mechanism of an extraintestinal pathogenic Escherichia coli (ExPEC) strain (LEB15) that exhibited decreased susceptibility to carbapenems. Methods The MICs were determined by a microdilution method. The β-lactamase-encoding gene was identified by PCR and sequencing, and the genetic environment was analysed by PFGE and PCR mapping. The genetic background was investigated by multilocus sequence typing (MLST). Virulence-factor-encoding genes and pathogenic islands (PAIs) were detected by multiplex PCR. Virulence was assessed in a mouse sepsis model. Results Strain LEB15 produced a chromosomal OXA-48 carbapenemase. The complete bla(OXA-48)-encoding Tn1999.2 transposon was inserted in the LEB15 chromosome. The strain belonged to an MLST cluster of emerging ExPEC strains (ST-127/ST-22). It had a high pathogenic score and eight PAIs (I536, II536, III536, IV536, VI536, I(CFT073), II(CFT073) and II(J96)) and induced an unusually high lethality in the mouse sepsis model. Conclusions Strain LEB15 combines both an atypical broad accumulation of virulence factors, which confers a strong killer phenotype, and a decrease in susceptibility to carbapenems following the chromosomal acquisition of bla(OXA-48). This association of virulence and carbapenemase in E. coli strains might pose major problems in the future for E. coli infection management.

Campylobacter species are a major cause of human diarrhoeal disease worldwide. In Lebanon, the true prevalence of Campylobacter infections and the species distribution in childhood diarrhoea are not known. This study in 2010 investigated the prevalence of Campylobacter species and its possible etiologic role in childhood diarrhoea in north Lebanon. A total of 90 stool samples from children (aged 1 month to 10 years) presenting with diarrhoea were collected from 5 hospitals. A polymerase chain reaction technique (PCR) was used for each sample forthe amplification of all Campylobacter species followed by 5 PCR reactions for the amplification of C. jejuni, C. hyointestinalis, C. coli, C. fetus and C. upsaliensis. Of the 90 samples, 10 were positive for Campylobacterspecies (11.1%):1 for C.coli, 1 for C. jejuni, 2 for both C. jejuni and C. coli, and 6 could not be identified to the species level with the available primers. Campylobacter species is frequently associated with childhood diarrhoea in north Lebanon but Campylobacter infection may be significantly underdiagnosed because the search for Campylobacter is not part of the routine stool culture.

Introduction: Bacteria of Aeromonas genus are ubiquitous organisms in aquatic environments. This work aims to explore the presence of four clinically relevant species in Lebanese waters and to study their susceptibility to antibiotics. Methods: One hundred water samples are collected in northern Lebanon from different sources (river, springs, wells, ponds, sea, chlorinated water and sewage) and analyzed by culture methods. The isolates were identified at genus level by a PCR assay targeting gcat gene. The presence of four species (A. hydrophila, A. caviae, A. media and A. veronii) was investigated by a multiplex PCR. The antibiotic susceptibility was also studied. Results: Aeromonas spp. was detected in 28% of investigated samples. In total, 38 isolates were identified as Aeromonas spp (10 out of 7 river water samples, 9 out of 35 spring, 9 among 26 wells, 5 out of 4 sewage samples, 2 out of 5 ponds, 2 out of 8 seawater samples and 1 out of 15 chlorinated water samples). Aeromonas hydrophila was the predominant species (19 isolates; 50%). The 3 other species were found to a lesser extent: A. caviae (3 isolates; 7.9%), A. veronii (2 isolates; 5.3%) and A. media (2 isolates; 5.3%). 12 other isolates (31.5%) remained unidentified by the used multiplex PCR technique. All isolates were resistant to more than one antibiotic. The most common resistance concerned beta-lactams. Conclusion: This study has highlighted the interesting distribution of these species in aquatic biotopes in Lebanon and the threat of potential transmission of these resistant strains to humans.

Cryptosporidium spp. are enteroparasites with worldwide distribution that infect the gastrointestinal tract of several vertebrates including humans. Human to human, zoonotic, foodborne and waterborne are reported as the main transmission routes of this parasite. Cryptosporidium spp. have been recognized as the predominant cause of waterborne and foodborne outbreaks. However, the epidemiological situation of cryptosporidiosis is not well known in Lebanon, a developing country with a population often affected by intestinal parasitic infections. This study was devoted to determine the prevalence and the genetic diversity of Cryptosporidium spp. in symptomatic hospitalized patients and in two children populations with different socio-economic level in North-Lebanon, as well as the risk factors associated with cryptosporidiosis. Fecal samples obtained from these populations were examined microscopically by modified Ziehl-Neelsen staining as well as nested PCR were done for the detection of Cryptosporidium oocysts. Out of 163 symptomatic hospitalized patients and 249 children, Cryptosporidium was present in 11% and 10.4% respectively according to microscopy examination and/or molecular tests. The genotyping showed the predominance of Cryptosporidium hominis in both populations. Subgenotype analysis of the isolates at the gp60 locus identified three subtypes IdA19, IbA10G2 and IaA18R3 for C. hominis and two subtypes IIaA15G1R1 and IIaA15G2R1 for C. parvum. Moreover, cryptosporidiosis was correlated with having meals outside home and presence of gastrointestinal symptoms especially diarrhea (p

Screening of Mutagenicity of Some Food Snacks Retailed on the Lebanese Market Usage of food additives has become more and more frequent. Possible incorporation of genotoxic chemicals in dietary products, especially in food snacks, urges the need for their assessment. A total of 127 samples of food snacks, retailed on the Lebanese market, were screened for mutagenic activity towards Salmonella typhimurium strains TA98 and TA100 using Muta-ChromoPlate assay. The food items fall into two separate categories: the first category abides by high standards internationally approved; the second category is of a lower cost and a general poor quality. The first category was found to show no mutagenic activity even after exogenous S9- mix activation. However, 35.8% of the second category samples exhibited mutagenicity at 99% of significance, although without metabolic activation. These alarming results imply that drastic measures should be undertaken in order to protect the Lebanese consumers from being exposed to a potential risk of mutagenicity induced by such a dietary source.

Background. – Staphylococcus aureus is one of the most significant pathogens causing significant morbidity and mortality. Moreover, the incidence of MLS-resistant Staphylococcus aureus infections continues to grow globally.Objective. – The aim of this study is to examine the expression of resistance of Staphylococcus aureus (S. aureus) isolates to MLS and the prevalence of genes involved in this resistance by PCR.Methods. – 38 strains of S. aureus MLS-resistant (resistant at least for one macrolide) were isolated in the sector of microbiology at Nini Hospital in North Lebanon. The disk diffusion method was used to determine the phenotype of the MLS resistance. The resistance genes involved were detected by PCR using specific gene primers for ermA, ermB, ermC, msrA, linA, mefA, vat and vgb genes.Results. – A total of 55.3% of the isolates were positive for inducible phenotype (iMLSB), 15.8% for the constitutive phenotype (cMLSB), 23.7% for MSB phenotype and 5.2% for L phenotype. The ermC gene was the most prevalent (52.6%), while ermA, ermB, msrA and linA genes were observed with lower prevalence. However, a combination of several of these genes was detected. The vgb, vat and mefA genes were not detected in any of the clinical isolates.Conclusion. – To our knowledge, this study is the first investigation regarding characterization of MLS resistance genes in clinical isolates of S. aureus in Lebanon. The study revealed a high prevalence of the inducible resistance to lincosamides (iMLSB phenotype) and the most prevalent resistance determinants was ermC.

Four hundred and sixty-four Pseudomonas aeruginosa strains were isolated in northern Lebanon at the Islami Hospital Microbiology department, in Tripoli. The purpose of this study was to evaluate the susceptibility of these strains to antibiotics, to compare this susceptibility according to the nature of the sample and the year of sampling. The results show that urinary samples were the most frequent (39.3%), followed by wound samples (21.2%), and ear samples (16.5%). The average rate of susceptible strains was 39.8% to ticarcillin, 56.9% to piperacillin, 58.2% to piperacillin + tazobactam, 74.1% to imipenem, 63.3% to ceftazidime, 60.4% to cefepime, 62.1% to aztreonam, 60.3% to netilmicin, 57.5% to gentamicin, 62.2% to tobramycin, 69% to amikacin, 100% to colistin, 45.4% to pefloxacin and ofloxacin, 57.7% to ciprofloxacin and 1.3% to rifampicin. The study showed that the strains isolated from pulmonary secretions were the most resistant to antibiotics.