Search

Armed conflicts are connected with huge migration and refugees of war transfer at borders often without appropriate checks for vaccination, or immunization calendars. Within the last 10 years due to war, sporadic cases of measles and polio have been exported from Syria to Israel or fromAfghanistan to Pakistan and vice versa (l2). The aim of this study was to compare occurrence of Tuberculosis in 2 shelters, 1 with refugees of war and 1 with orphans, 1 from Ukraine and the second in Cambodia and a shelter of homeless people in Jarna Slovakia (3 countries of different incidence of TB).

Introduction: Massive internal displacement of Iraqi civilian in Autonomous Kurdistan led to humanitarian catastrophe. The aim of the study is to assess comparison of communicable to non-communicable diseases among the internally displaced in Autonomous Kurdistan. Patients and Methods: In an open cohort two arm study, children vs adults and communicable vs non-communicable diseases, the occurrence of infectious and non-infectious diseases were compared during the first 6 months of 2016. Within the selected population of refugees

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

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).

Introduction: The aim of this situation analysis was to compare two phases, acute and post-acute, of disease epidemiology among refugees in the first 6 months (i) and a second 6 months post-acute (ii) period after displacement to an UNNCR camp within the Slovak Field Clinic. Patients and Methods: All together, 3,503 refugees appeared before an humanitarian team at a Mobile Clinic in Dohuk and Sinjar close to the transit border in Northwestern Kurdistan where about 1 million people were displaced after ISIS took over Mosul with its 3 million inhabitants. Results: In the post-acute period, only 18 cases of diarrhea in four camps is a sign of safe water and high health food standard safety in the designated (UNHCR) camps. Conclusion: Typical infectious in overcrowded camp populations such gastroenteritis, diarrhea, Hepatitis A, were absent in our group of refugees and migrants. Original Articles 43 Clinical Social Work and Health Intervention Clinical Social Work and Health Intervention Vol. 7 No. 3 2016 Introduction The aim of this situation analysis was to compare two phases, acute and post-acute, of disease epidemiology among refugees in the first 6 months (i) and a second 6 months post-acute (ii) period after displacement to an UNNCR camp within the Slovak Field Clinic. Patients and Methods The 3,503 visits appeared before a three person humanitarian team at a Mobile Clinic in Dohuk and Sinjar close to a transit border in Northwestern Kurdistan. There are about 1 million people displaced after ISIS took over of Mosul with its 3 million inhabitants. The spectrum of disease was compared in acute and post-acute periods with a chi-square-test (EpiInfo, CDC) in a univariate analysis. Results and Discussion In the post-acute period, that only 18 cases of diarrhea were found in four designated UNHCR camps in Sinjar is a sign of safe weather and food safety and high public health standards in the camps. Pneumonia (40 vs. 32 cases P˂0,07) was more commonly represented, less than 5% in both periods; as well as upper RTI despite seasonal weather (242 vs. 110 cases). This difference was significant (P˂0,01) showing surprisingly more RTI in winter (postacute) versus the autumn (acute) period. From other infectious diseases only scabies was represented in several cases in both periods. Of interest was that vaccination status for all patients was complete and well documented. Therefore, after the first case of diphtheria only a surveillance alert was given; in the second period (2 of 1,798 vs. 1 of 1,705, P=NS) with no severe emergency clinical course, no health alert (8-10) was necessary to declare. Conclusions Due to good sanitary infrastructure supply and safe water (i) and food safety (ii), diarrheal diseases are surprisingly sporadic. The majority of visits were due to upper respiratory tract infections. Scabies from ectoparasitis, was the commonest in this group of displaced refugees in North Kurdistan.

The aim of this study was to prospectively investigate 120 cases of viridans streptococcal bacteraemia (VSB) in 117 patients in major university hospitals in Slovakia in 2000-2002 (3 y) for antibacterial susceptibility, risk factors and outcome. From 127 episodes, 16 (13%) of VSB were caused by PEN-R strains and 13 (10%) by ERY-R strains. 32 cases had cancer as underlying disease (20 haematological), 41 had endocarditis and 35 were elderly (65 y of age) patients. Concerning mortality, 29 of 127 patients died (24%). There were several risk factors associated with mortality. Solid tumour as underlying disease (p0.02), stroke (p0.002), concomitant lung infection (p0.01), endoscopic procedure (p0.036), intubation (p0.0008), ventilatory support (p0.002), and coma (p0.009) were associated with more deaths. A comparison of 115 bacteraemias to 13 bacteraemias caused by erythromycin-resistant strains of Streptococcus viridans was performed. There were no significant differences in underlying disease, risk factors and mortality. Erythromycin resistance in bacteraemias caused by S. viridans did not have significant impact on outcome of the patients, nor did it show specific relation to analysed risk factors in our study. 14.5% of VSB were cause by PEN-resistant viridans streptococci. Risk factors for penicillin resistance were ventilatory support (p0.01), intubation (p0.001) and resistance to other antibiotics: 8 of 16 (50%) of PEN-R VSB were resistant also to erythromycin or cotrimoxazole or tetracycline compared with 9% of PEN-R VSB (p0.005). Endoscopic procedures in the upper respiratory system were at risk for development of PEN-R VSB. There was also difference in outcome; 71% vs 22.5% (p0.0002) of cases infected with PEN-R VSB died compared to PEN-S VSB. PEN-R is therefore clinically significant in VSB.

Objectives To compare the clinical and radiographic results for locked intramedullary (IM) nails and plates used in the treatment of humeral diaphyseal fractures. Design Prospective randomization by sealed-envelope technique of eighty-four patients into two study groups: those treated by intramedullary nailing (IMN group; n = 38) and those treated by compression plating (PLT group; n = 46). Setting Patients admitted consecutively to a university-affiliated Level I trauma center. Patient/participants All skeletally mature patients admitted to Harborview Medical Center with acute humeral shaft fractures requiring surgical stabilization. Fractures of the diaphysis were defined as being at least three centimeters distal to the surgical neck and at least five centimeters proximal to the olecranon fossa. Intervention Treatment with locking antegrade intramedullary humeral nails (Russell-Taylor design [Smith and Nephew Richards]) or with 4.5-millimeter dynamic compression and limited contact dynamic compression plates (AO design [Synthes]). Main outcome measurements Clinical outcome measurements included fracture healing, radial nerve recovery, infection, and elbow and shoulder discomfort. Radiographic measurements included fracture alignment, time to healing, delayed union, and nonunion. Results Follow-up averaged thirteen months. Forty-two fractures (93 percent) in the PLT group were healed by sixteen weeks versus thirty-three fractures (87 percent) in the IMN group (p = 0.70). Shoulder pain and a decrement in shoulder range of motion (ROM) were significant associations with IMN (p = 0.007 for both variables) but not with PLT. A decrement in elbow ROM was significantly associated with PLT (p = 0.03), especially for fractures of the distal third of the diaphysis, whereas elbow pain was not (p = 0.123). The sum of other complications demonstrated nearly equal prevalence for both treatment groups. Conclusions For patients requiring surgical treatment of a humeral shaft fracture, intramedullary nailing and compression plating both provide predictable methods for achieving fracture stabilization and ultimate healing.

Objective To determine patterns of nasopharyngeal colonisation in HIV-positive children. Methods Nasopharyngeal, nasal and ear swabs were prospectively taken from all children living in two paediatric nursing homes for HIV-positive orphans in Cambodia from 2004 to 2011. Results A total of 882 swabs were taken, of which 586 tested positive for bacteria. Staphylococcus aureus was the most frequently isolated species (178 isolates; 30.4%) followed by Streptococcus pneumoniae (103 isolates; 17.6%) and Klebsiella pneumoniae (99 isolates; 16.9%). The rate of S. pneumoniae decreased in 2009 when a vaccination programme was introduced. Conclusions The respiratory tract of HIV-positive children receiving highly active antiretroviral therapy is commonly colonised by S. aureus and S. pneumoniae, while other species normally found in the respiratory tract, such as Moraxella catarrhalis, are far less frequent. Objectif Determiner les profils de colonisation du rhinopharynx chez les enfants VIH-positifs. Methodes Des prelevements par ecouvillons du rhinopharynx, du nez et des oreilles ont ete prospectivement effectues chez tous les enfants vivant dans deux centres de soins infirmiers pediatriques pour orphelins VIH-positifs au Cambodge, de 2004 a 2011. Resultats 882 prelevements ont ete effectues, dont 586 ont ete trouves positifs pour des bacteries. Staphylococcus aureus etait l'espece la plus frequemment isolee (178 isolats; 30.4%) suivie de Streptococcus pneumoniae (103 isolats; 17.6%) et Klebsiella pneumoniae (99 isolats; 16.9%). Le taux de S. pneumoniae a diminue en 2009 quand un programme de vaccination a ete introduit. Conclusions Les voies respiratoires des enfants VIH-positifs recevant un traitement antiretroviral hautement actif est generalement colonises par S. aureus et S. pneumoniae, tandis que d'autres especes normalement presentes dans le tractus respiratoire, telle que Moraxella catarrhalis, sont beaucoup moins frequentes. Objetivo Determinar los patrones de la colonizacion nasofaringea en ninos VIH positivos. Metodos De forma retrospectiva se recogieron frotis nasofaringeos, nasales y de oido a ninos viviendo en dos orfanatos para huerfanos VIH positivos en Cambodia, entre 2004 y 2011. Resultados Se tomaron 882 frotis, de los cuales 586 dieron positivo para bacterias. Staphylococcus aureus era la especie mas frecuentemente aislada (178 aislados; 30.4%), seguida por Streptococcus pneumoniae (103 aislados; 17.6%) y Klebsiella pneumoniae (99 aislados; 16.9%). La tasa de S. pneumoniae disminuyo en el 2009 cuando se introdujo el programa de vacunacion. Conclusiones El tracto respiratorio de ninos VIH positivos recibiendo terapia antirretroviral de gran actividad normalmente esta colonizado por S. aureus y S. pneumoniae, mientras que otras especies normalmente encontradas en el tracto respiratorio, como Moraxella catarrhalis, son mucho menos frecuentes.

We aimed to assess the occurrence of malaria-positive cases in 4 rural Burundian hospitals during December 2011 placed at different altitudes above sea level.Diagnosis of malaria was made upon considering clinical symptoms, microscopic evaluation and rapid diagnostic test results. We performed analysis of patient's clinical data collected in 4 hospitals in Burundi to compare the occurrence of malaria at different altitudes.The lowest incidence of malaria during December 2011 was detected at Murago Hospital (606 cases per month, 47.6%), which is located in the highest altitude, and the highest occurrence was in Gasura (1,559 cases, 91.3%), then in Rutovu (732 cases, 81.2%) and Buraniro (4,436 cases, 78.6%). Compared with other types of consultations (gynecological, HIV/AIDS, other tropical diseases), malaria was the most frequent reason for medical consultation.We have observed the lowest occurrence of malaria at hospitals located in the highest altitude. Despite the lower number of malaria cases in higher altitudes, its impact on public health should not be underestimated.

Neuropsychic manifestations of AIDS are still noticeable especially in developing countries. The aim of this short communication is to describe psychological, behavioral and neurologic disorders caused by either HIV-related disorders, or drug related toxicities in HIV-infected children from Cambodia (Phnom Penh, Sihanoukville) treated during 10 years with highly active antiretroviral therapy (HAART).One hundred and thirty seven (137) HIV-positive children (age 2-19 years) treated with HAART since 2003 (6-10 years follow up) have been analyzed concerning opportunistic infections, other co-infections, renal parameters, hematologic parameters, chest X-ray, antiretroviral treatment, anti-tuberculotics and antibiotics treatment. We recorded prospectively all data since the start of HAART from 2003-2005 up to December 2012.Occurrence of drug related neuritis due to stavudine (HAART) was less than 1% and was associated with anti-tuberculous agents accompanying HAART in HIV- and tuberculosis co-infected patients. Co-infections with neurotropic viruses were more frequent: 1 case of CMV retinitis, 18 cases of herpes zoster neuritis and 37 cases of generalized HZV infections (varicella), after onset HAART in children were recorded. All children responded well to anti-viral therapy with ganciclovir (CMV), vanciclovir or acyclovir (HZV) in combination with first line HAART.Neurologic disorders in children with HAART are less frequent than in adults. Anti-retrovirals and anti-tuberculosis drugs seem to be safe and less toxic in children then in adults. Co-infections with neurotropic viruses were more frequent, however, were successfully treated with anti-virals.

Infections involving the central nervous system have very serious consequences and affect thousands of people in Africa. Despite the availability of new antibiotics and vaccines, neuroinfections act as dangerous and life-threatening conditions. The most frequent neuroinfections which are of the greatest importance for public health systems are viral diseases (such as HIV, encephalitis, poliomyelitis, rabies), bacterial diseases (bacterial meningitis, neurological complications of leprosy and tuberculosis) and parasitic infections (cerebral malaria, sleeping sickness, trypanosomiasis, schistosomiasis, toxoplasmosis etc.).A descriptive study to assess the occurrence of neuroinfections in two rural hospitals in Sudan (Mapuordit in Yirol and Gordim in Aweil) was performed in two periods of two years: (i) 2005-2006 and (ii) 2010-2011. We obtained data on patients from Mapuordit and from Gordim by studying their medical records.Several cases of neuroinfections were observed during both periods; those were represented by tetanus, meningococcal meningitis, leprosy with neuropathy (altogether 442 patients) in Mapuordit. Also in Gordim, severe neuroinfections such as cerebral malaria were very rare (1 case), as well as tetanus (1 case), meningococcal meningitis (8 cases) and sleeping sickness (9 cases). However, the incidence of neuroinfections decreased from 44/1000 in 2005-2006 to 2/1000 in 2010-2011.Decreased incidence of serious neuroinfections (cerebral malaria, sleeping sickness, meningococcal meningitis) in Sudan may be related to improvement of effective therapeutic options, represented by (i) intermittent preventive therapy (IPT) for malaria, (ii) by suppression of sleeping sickness vectors and (iii) by better accessibility of antibiotics.

This study begins with interpreting basic academic results from the House of Family (HOF) comprehensive project for HIV/AIDS orphaned children. We reviewed school performance during the academic period from 2007 to 2012.All the children in the HOF project have vertically acquired HIV infection, with approximately 90% being with AIDS/Clinical Stage C at the time of admission. Initiation of antiretroviral drugs (ARV) was at the average age of 7 (mean 6.94, median 6.5, and a mode of 6). In the year 2007, 44 children had been receiving ARV. The majority of these children 32 (72.7%) were on ARV for at least 1 year, 6 (13.6%) of the children on ARV for 4 years, 7 (15.9%) were on ARV for 3 years, 5 (11.3%) for 2 years, 14 (31.8%) for 1 year, and 12 (27.2%) started ARV on that year. Later on, an additional 2 children started ARV in 2008, 1 child in 2009, and 4 children in 2010.We found that the total number of children achieving a certain academic level changed very little between each scholastic year. During the four years of school reviewed, it was noted that the Poor performers made improvement and an increase in Good performance grades was also achieved. The trend of Fair levels remained mostly unchanged at 65%, 70.2%, 68.5%, and 64.6% respectively. The overall passing performance, including both Fair and Good scores, improved from 67.5% in 2008 to 80.8% the following year of school. This passing rate of 80.8% in 2009 remains stable over the next two years at 80.3% and 80.3% respectively.Despite the late introduction of ARV medicine, limited family and social support, and deficient academic achievement, the children of HOF were able to improve their school performance due to intensified psychosocial and educational support provided at the HOF comprehensive project.

Str. pneumoniae isolates were susceptible to penicillin, all to also ofloxacin and chloramphenicol and cefotaxim and 39 (100%) to cotrimoxazol. Concerning S. aureus, all isolates 22 were susceptible to oxacillin and chloramphenicol, and 21 also to cotrimoxazol. All N. meningitidis isolates but one-10 of all were susceptible to penicillin, all to cefotaxim, chloramphenicol and cotrimoxazol. All H.influenzae isolates were susceptible to ampicillin and chloramphenicol, as well as to ofloxacin and cotrimoxazol. Those surprisingly high susceptibilities to rather "old" antibiotics may be explained by low antibiotic consumption, accessibility and therefore low usage which is a key promoter of resistance both in community and hospital.

Malaria should not be present in altitudes more than 1,800 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.

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.

Etiology, risk factors, treatment and outcome of 21 cases of bacterial meningitis diagnosed in excessive alcohol consumers within 5 years of national community acquired meningitis survey in Slovakia is reported.

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.

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 (p0.001), Enterobacteriaceae (p=0.01) and Acinetobacter baumannii (p=0.0008) isolated from CSF and vice versa Streptococcus pneumoniae (p0.001), Neisseria meningitis (p0.001) and Haemophillus influenza (p=0.0009) were more commonly isolated from CSF in CBM. Neurosurgery (p0.001), sepsis (p=0.006), VLBW neonates (p=0.00002) and cancer (p=0.0007) were more common in PM and alcohol abuse (p0.001) as well as otitis/sinusitis (p0.001) and Roma ethnic group (p=0.001) in CAM. Initial treatment success was significantly more frequently observed among CAM (p0.001) 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).

We have been unable to document a benefit of a combination of aminoglycosides with betalactam or carbapenem antibiotics in nosocomial meningitis. This was similar to the cases of sepsis, where survival of patients did not improve with combination therapy. Combination therapy did not increase the chance of appropriateness of the therapy. 30% of those on combination therapy were considered as inappropriately treated in comparison to 2.8% of those on monotherapy (p0.01).

Streptococcus agalactiae is a rare cause of neonatal meningitis in the era of peripartum prophylaxis with prophylaxis with ampicillin in colonized/infected mothers. However 5 cases of meningitis among 171 cases of pediatric nosocomial meningitis database within last 15 years occurred. All 5 children were neonates (one VLBW and early gestation newborn), 2 after neurosurgery. All 5 cases were successfully cured with a combination of cefotaxim (or ceftazidim) plus aminoglycosides, in one case also with addition of vancomycin or ampicillin. However 3 of 5 cured patients had neurologic sequellae, two of them reversible hydrocephalus and in speech retardation.

Review of 497 cases of neuroinfections in 7 tropical clinics in Ethiopia, Uganda, Burundi, Kenya, Sudan within 2000-2007 was performed. 97.5% of all cases was cerebral malaria (40.1%) and bacterial meningitis (56.4%). TB meningitis, cerebral cryptococcosis and sleeping sickness were very rare.

Meningitis after artificial implants in 60 children, mainly after foreign body infections (FBI) was caused more frequently by coagulase negative staphylococci and Ps. aeruginosa than other organisms and was significantly associated with perinatal trauma, hydrocephalus, haemorrhage or VLBW and had more neurologic sequels despite mortality was similar to other nosocomial meningitis.

Nosocomial neuroinfections due to Enterobacteriaceae represented 9.5% in our cohort of 171 cases of paediatric meningitis within last 15 years. Commonest etiologic agents was E. coli - 9 (50%) followed by Klebsiella pneumoniae - 3 (16,7%) and Enterobacter cloacae. Citrobacter freundii, Proteus mirabilis and Salmonella enteritidis (1 each). Commonest risk factors were neonatal age 13 - (72.2%), very low birth weight 5 (27.8%), craniocerebral trauma - 4 (22.2%) and neurosurgery - 5 (27.8%). All but 1 case were treated with antibiotics: 8 with III-rd and 3 with IV-th generation cephalosporins (ceftazidim, cefotaxim and cefepim) 2 with meropenem and 4 with ciprofloxacin: Nosocomial meningitis due to enterobacteriaceae was associated with significantly high mortality (29.9% vs. 15.1% in all cohort of pediatric meningitis - p0.02).

Within last 15 years, analyzing patterns of etiology and resistance in organisms causing neuroinfections, emergence of resistance has been observed in Slovakia in S. haemolyticus to teicoplanin (11%), Ps. aeruginosa and A. baumannii to meropenem (20%) and Candida spp. (non-albicans Candida spp.) to fluconazol (20%). There are no new antibiotics against carbapenem resistant Ps. aeruginosa and Acinetobacter baumannii.

Enterococcal meningitis is a rare complication of neurosurgical procedure or high technology treatment of children and occurs mainly imunocompromised neonates with very low birth weight, severe prematurity and complicates sometime ventriculoperitoneal shunt insertion or perinatal trauma. E. faecalis caused 10 nosocomial meningitis and all strains were susceptible to vancomycin and chloramphenicol, and in our database 90% also to gentamicin and ampicillin. Mortality in our group of 10 children was 20% what is insignificantly higher than overall mortality in the whole cohort of meningitis within last 15 years in our database (15.1%). Early empiric therapy should include also ampicillin or vancomycin, if enterococcal etiology is suspected.

Analysing 101 cases of nosocomial meningitis due to staphylococci other than S. aureus within last 15 years, coagulase negative staphylococci represented the commonest pathogen. Major risk factor for staphylococcal meningitis was prior neurosurgery, mainly ventriculoperitoneal shunt insertion. Ten of 101 cases were caused by glycopeptide intermediate resistant strains in patients pretreated with multiple combination of antibiotics including vancomycin and shunt exchanges: 76% of strains were also oxacillin resistant.

There is very little data and no prospective research possible in the field of catastrophic medicine (disaster medicine) including infectious diseases. This minireview tries to contribute to the pathogenesis and outcome of infectious diseases in areas after anthropogenic (war, genocide, terrorist attack, industrial disasters) and non anthropogenic (natural) catastrophes (earthquake, floods, tsunamis, hurricanes, volcano eruptions). Therefore ISC received a proposal to create a working group on infectious diseases in areas after catastrophes, better to understand epidemiology, prevention and therapy of infectious diseases occurring in conjunction to various anthropogenic and non anthropogenic (natural) disasters.