Surveillance of Australian Hajj pilgrims for carriage of potentially pathogenic bacteria:Data from two pilot studies

AIM To estimate the pharyngeal carriage rate of Neisseria meningitidis(N. meningitidis), Streptococcus pneumoniae(S. pneumoniae) and Staphylococcus aureus(S. aureus) among Australian Hajj pilgrims.METHODS In 2014, surveillance was conducted in two phases among Australian Hajj pilgrims: The first phase during Hajj in Mina, and the second phase soon after returning home to Australia. Nasopharyngeal or oropharyngeal swabs were taken from participants then tested, firstly by nucleic acid testing, and also by standard culture.RESULTS Of 183 participants recruited in the first phase, 26(14.2%) tested positive for S. pneumoniae; 4 had received pneumococcal conjugate vaccine(PCV13). Only one tested positive for N. meningitidis(W). Of 93 2^(nd) phase samples cultured, 17(18.3%) grew S. aureus, all methicillin sensitive, 2(2.2%) grew N. meningitidis(on subculture; one serotype B, one negative), and 1(1%), from an unvaccinated pilgrim, grew S. pneumoniae.CONCLUSION Relatively high carriage of S. pneumoniae and little meningococcal carriage was found. This indicates the importance of a larger study for improved infection surveillance and possible vaccine evaluation.

Australian tertiary care outcomes of entecavir monotherapy in treatment naive patients with chronic hepatitis B

AIM:To evaluate the long-term treatment outcomes of entecavir monotherapy in treatment naive patients in an Australian tertiary care setting. METHODS:A retrospective analysis of treatment naive patients receiving entecavir monotherapy through Westmead Hospital was performed.Patients were excluded if they had received previous treatment with another nucleoside or nucleotide analogue,were pregnant or less than 18 years old. RESULTS:Out of 336 patients,163 patients fulfilled the selection criteria.Range of follow up was 3-46 mo (mean 26 mo).134 patients(82.2%)had pre-treatment biopsies,with 26 patients(16.0%)demonstrating F3-4 fibrosis.In total,153 patients(93.9%)achieved at least Partial Virological Suppression(PVS),with 134 patients (82.2%)achieving complete virological suppression. The cumulative CVS and PVS rates at 36 mo were 82.1%and 96.4%,respectively.3 patients(1.8%)failed to achieve PVS,while 5 patients(3.0%)developed virological rebound.128 patients(78.5%)maintained CVS throughout follow up.Predictors of CVS included lower baseline DNA level(P=0.001),hepatitis B virus e antigen negative status(P=0.001)and increasing age at treatment(log rank 0.001).No significant adverse effects were reported necessitating cessation of entecavir. CONCLUSION:Entecavir monotherapy is efficacious and safe in an Australian tertiary care setting.Resistance and rebound rates are very low.This is similar to data from controlled and uncontrolled trials around the world.

Viral respiratory infections among Hajj pilgrims in 2013

Middle East respiratory syndrome coronavirus(MERS-Co V) has emerged in the Arabian Gulf region, with its epicentre in Saudi Arabia, the host of the ‘Hajj' which is the world's the largest mass gathering. Transmission of MERS-Co V at such an event could lead to its rapid worldwide dissemination. Therefore, we studied the frequency of viruses causing influenza-like illnesses(ILI) among participants in a randomised controlled trial at the Hajj 2013. We recruited 1038 pilgrims from Saudi Arabia, Australia and Qatar during the first day of Hajj and followed them closely for four days. A nasal swab was collected from each pilgrim who developed ILI. Respiratory viruses were detected using multiplex RT-PCR. ILI occurred in 112/1038(11%) pilgrims. Their mean age was 35 years, 49(44%) were male and 35(31%) had received the influenza vaccine pre-Hajj. Forty two(38%) pilgrims had laboratory-confirmed viral infections; 28(25%) rhinovirus, 5(4%) influenza A, 2(2%) adenovirus, 2(2%) human coronavirus OC43/229 E, 2(2%) parainfluenza virus 3, 1(1%) parainfluenza virus 1, and 2(2%) dual infections. No MERS-Co V was detected in any sample. Rhinovirus was the commonest cause of ILI among Hajj pilgrims in 2013. Infection control and appropriate vaccination are necessary to prevent transmission of respiratory viruses at Hajj and other mass gatherings.

Proposed nomenclature for Pseudallescheria,Scedosporium and related genera

As a result of fundamental changes in the International Code of Nomenclature on the use of separate names for sexual and asexual stages of fungi,generic names of many groups should be reconsidered.Members of the ECMM/ISHAM working group on Pseudallescheria/Scedosporium infections herein advocate a novel nomenclature for genera and species in Pseudallescheria,Scedosporium and allied taxa.The generic names Parascedosporium,Lomentospora,Petriella,Petriellopsis,and Scedosporium are proposed for a lineage within Microascaceae with mostly Scedosporium anamorphs producing slimy,annellidic conidia.Considering that Scedosporium has priority over Pseudallescheria and that Scedosporium prolificans is phylogenetically distinct from the other Scedosporium species,some name changes are proposed.Pseudallescheria minutispora and Petriellidium desertorum are renamed as Scedosporium minutisporum and S.desertorum,respectively.Scedosporium prolificans is renamed as Lomentospora prolificans.

Multilocus sequence typing indicates diverse origins of invasive Candida tropicalis isolates in China

Background According to data from the China Hospital Invasive Fungal Surveillance Net （CHIF-NET） 2010, Candida tropica/is （C. tropica/is） is the third most common pathogen causing invasive candidiasis. Moreover, the majority of fluconazole-resistant C. tropicalis isolates were from a single hospital. Therefore, a molecular epidemiological survey is necessary to investigate the genetic relatedness of C. tropica/is isolates in China. Methods In this study, 48 C. tropicalis isolates causing invasive fungal infections from four tertiary hospitals in China were studied. All the isolates were identified by sequencing the internal transcribed spacer region. Antifungal susceptibility to triazoles, amphotericin B, and caspofungin was determined by the Clinical and Laboratory Standards Institute standard broth microdilution method. Multilocus sequence typing （MLST） was performed, and phylogenetic analysis was further performed by the eBURST and maximum parsimony （MP） methods to characterize the genetic relatedness of isolates. Results MLST discriminated 40 diploid sequence types （DSTs） among 48 isolates, including 36 novel DSTs, and the XYR1 gene showed the highest discriminatory power. The DSTs obtained from this study were compared with those of previously reported C. tropicalis isolates, and there was poor type alignment with regional strains. Nine groups and 11 singletons were identified by eBURST, whereas two groups and 10 subgroups were clustered by MP analysis. Generally, there were no obvious correlations between clonal clusters generated and the specimen source or hospital origin. Seven fiuconazole-resistant isolates were confirmed and assigned to three distinguishable branches. Conclusions The results suggested diverse origins of invasive C. tropicalis isolates in China. Although most invasive C. tropicalis strains in the mainland of China were clustered with previously characterized Asian isolates, major C. tropicalis clusters identified in this study were genetically distinct from those of other geographic regions.