Escherichia coli O157:H7 in Malta

E coli O157:H7 infection causes a wide spectrum of disease ranging from asymptomatic carriage to severe disease leading to death. Typical disease includes a non-bloody diarrhoea, haemorrhagic colitis, HUS and thrombotic thrombocytopaenic purpura. While the incubation period is commonly 3-4 days, it can range from one to eight days. In this article the author describes the epidemiology, the clinical features and the microbiology of the infection, whilst giving a short view of the local situation.peer-reviewe

Drug Resistant Streptococcus pneumoniae (DRSP) in the Maltese Islands

The DRSP prevalence rate for the Maltese Islands was investigated. Consecutive samples were obtained, both from adults and children, from September 2000 through April 2002. Penicillin-intermediately-resistant isolates amounted to 27%, erythromycin-resistant isolates 31%, and clindamycin-resistant isolates 19%. The oxacillin disk was found to be an effective screening method for the detection of penicillin resistance. An association was found in patients who had DRSP, as well as diabetes and/ or cardiovascular disease. Finally, an investigation of the local antibiotic consumptions over the period 1997-2000, for the National Health Service was conducted. The highest consumption rates were obtained with co-amoxiclav, amoxicillin, erythromycin, cephalexin and ciprofloxacin. The results obtained here call for more judicious use of antibiotics. In addition, the setting up of a local DRSP surveillance unit is mandatory. Moreover, the use of molecular techniques to investigate specific genes, such as ermAM and mefE associated with macrolide-resistance, should be introduced as part of investigational laboratory work.peer-reviewe

Escherichia coli O157:H7 in Malta for the first time

The emergence of E coli O157:H7 in Malta is a sign of the times. It represents one of the newly emerging infections associated with food. The first two documented cases of E coli 0157:H7 infection in Malta occurred in July and August, 1996. Food types classically incriminated were surveyed by the Department of Public Health. Epidemiological investigation aimed to trace the environmental sources of infection.• Microbiology was performed jointly by diagnostic and public health laboratories. Facts about infection and control of the disease are highlighted with a view to alerting local practitioners to the condition.peer-reviewe

Puerperal Streptococcus pneumoniae endometritis : a case report and literature review

Streptococcus pneumoniae endometritis is an exceedingly rare clinical occurrence in the immunocompetent individual. This case report describes such an occurrence in an otherwise healthy woman 39 days post-normal vaginal delivery. The patient responded to prompt broad-spectrum intravenous antibiotics and made a full recovery. The clinical relevance of such a scenario, the likely pathogenesis of the event as well as a brief review of relevant clinical literature are discussed. Streptococcus pneumoniae genital infection was a well-documented clinical entity in the pre-antibiotic era with a high mortality rate – 26% for localised infection and 74% for peritonitis and sepsis. More recently, however, there have been only isolated reports of Streptococcus pneumoniae genital infection, with even less frequent accounts of this happening in immunocompetent individuals. In this report, we document a case of Streptococcus pneumoniae endometritis in a young, previously healthy female 39 days post-partum.peer-reviewe

A focus on the newer antibiotics targeting Gram-positive bacteria

The incidence of antimicrobial resistance has continued to rise with a threat to return to the “pre-antibiotic” era. This has included a sharp increase in multi-drug resistant organisms, which may cause life-threatening infections. Efforts have been made to develop new antibiotics with novel modes of action, aimed at acting against these multi-drug resistant strains. This review aims to focus on newly available and investigational antibiotics targeting Grampositive organisms. It is likely that these antibiotics will be used mainly in a secondary care setting; however primary care health care professionals also need to have an understanding of these antibiotics, since patients may be discharged home on them.peer-reviewe

Periodic shock-emission from acoustically driven cavitation clouds:a source of the subharmonic signal

Single clouds of cavitation bubbles, driven by 254 kHz focused ultrasound at pressure amplitudes in the range of 0.48–1.22 MPa, have been observed via high-speed shadowgraphic imaging at 1 × 10⁶ frames per second. Clouds underwent repetitive growth, oscillation and collapse (GOC) cycles, with shock-waves emitted periodically at the instant of collapse during each cycle. The frequency of cloud collapse, and coincident shock-emission, was primarily dependent on the intensity of the focused ultrasound driving the activity. The lowest peak-to-peak pressure amplitude of 0.48 MPa generated shock-waves with an average period of 7.9 ± 0.5 μs, corresponding to a frequency of f₀/2, half-harmonic to the fundamental driving. Increasing the intensity gave rise to GOC cycles and shock-emission periods of 11.8 ± 0.3, 15.8 ± 0.3, 19.8 ± 0.2 μs, at pressure amplitudes of 0.64, 0.92 and 1.22 MPa, corresponding to the higher-order subharmonics of f₀/3, f₀/4 and f₀/5, respectively. Parallel passive acoustic detection, filtered for the fundamental driving, revealed features that correlated temporally to the shock-emissions observed via high-speed imaging, p(two-tailed) 200 μm diameter, at maximum inflation), that developed under insonations of peak-to-peak pressure amplitudes >1.0 MPa, emitted shock-waves with two or more fronts suggesting non-uniform collapse of the cloud. The observations indicate that periodic shock-emissions from acoustically driven cavitation clouds provide a source for the cavitation subharmonic signal, and that shock structure may be used to study intra-cloud dynamics at sub-microsecond timescales

The effects of socioeconomic determinants on hypertension in a cardiometabolic at-risk European country

Background. A relationship has been established between socioeconomic status and hypertension. The aim of this study was to determine the prevalence of hypertension and to explore the links between hypertension and socioeconomic factors in the adult population of Malta. Methods. A national representative cross-sectional health examination study was performed between 2014 and 2016. Sociodemographic and medical history data was gathered by validated questionnaires while blood pressure was measured. Prevalence rates of known hypertension, newly hypertension, and global hypertension were calculated. Associations between sociodemographic characteristics and hypertension were identified through logistic regression models. Results. Hypertension contributed to 30.12% (CI 95%: 28.71–31.57) of the study population, with a male preponderance. The majority was known hypertensive (73.59% CI 95%: 71.01–76.02), with only three-quarters on medication. Multivariant analyses showed that increasing age and body mass index, male gender, and living in Gozo, Western district, and Northern Harbour district were associated with having hypertension. Conclusion. Hypertension is a problem in Malta especially in the male population and with increasing age and body mass index. Education did not exhibit any associated risk for having hypertension, which is inconsistent with the literature, while habitat localities played a role in hypertension development.peer-reviewe

Diabetes, pre-diabetes and their risk factors in Malta : a study profile of national cross-sectional prevalence study

Type 2 diabetes mellitus constitutes a global epidemic and a major burden on health care systems across the world. Prevention of this disease is essential, and the development of effective prevention strategies requires validated information on the disease burden and the risk factors. Embarking on a nationally representative cross-sectional study is challenging and costly. Few countries undertake this process regularly, if at all. This paper sets out the evidence-based protocol of a recent cross-sectional study that was conducted in Malta. Data collection took place from November 2014 to January 2016. This study presents up-to-date national data on diabetes and its risk factors (such as obesity, smoking, physical activity and alcohol intake) that will soon be publicly available. This protocol was compiled so that the study can be replicated in other countries. The protocol contains step-by-step descriptions of the study design, including details on the population sampling, the permissions required and the validated measurement tools used.peer-reviewe

Methicillin resistant S. Aureus in autopsy cases

Objective: To determine whether hospital stay predisposes to nasal colonisation with Staphylococcus aureus and Methicillin Resistant S. aureus (MRSA). Method: Nasal swabs were taken from cadavers undergoing post-mortem examinations at the mortuary of St. Luke’s Hospital. The swabs were taken to the Bacteriology Laboratory where attempts were made to culture S. aureus. Vitek® Gram Positive Susceptibility Cards were used for antibiotic susceptibility. MRSA positive organisms were tested using Penicillin Binding Protein Latex Agglutination. Key Findings: Ninety-three swabs were taken. The proportion of S. aureus nasal carriage was similar in both hospitalised and non-hospitalised groups. However, 8 out of 15 (53%) S. aureus carriers in the hospitalised group were MRSA positive, compared to 4 out of 19 (21%) S. aureus carriers in the non-hospitalised group. Conclusion: Hospitalisation increases the incidence of MRSA carriage compared to the non-hospitalised population.peer-reviewe

An evaluation of the prevalence of Mycobacterium marinum in aquaria and its impact on man

Mycobacterium marinum is a pathogenic organism normally found in aquaria and is the cause of fish tuberculosis. However, it also has the zoonotic potential to affect humans. Granulomatous lesions of the hands are the common presenting manifestation and while this infection is generally cutaneous, it can disseminate if not treated.peer-reviewe