Clinical and molecular epidemiological features of coronavirus HKU1-associated community-acquired pneumonia

Background. Recently, we described the discovery of a novel group 2 coronavirus, coronavirus HKU1 (CoV-HKU1), from a patient with pneumonia. However, the clinical and molecular epidemiological features of CoV-HKU1-associated pneumonia are unknown. Methods. Prospectively collected (during a 12-month period) nasopharyngeal aspirates (NPAs) from patients with community-acquired pneumonia from 4 hospitals were subjected to reverse-transcription polymerase chain reaction, for detection of CoV-HKU1. The epidemiological, clinical, and laboratory characteristics of patients with CoV-HKU1-associated pneumonia were analyzed. The pol, spike (S), and nucleocapsid (N) genes were also sequenced. Results. NPAs from 10 (2.4%) of 418 patients with community-acquired pneumonia were found to be positive for CoV-HKU1. All 10 cases occurred in spring and winter. Nine of these patients were adults, and 4 had underlying diseases of the respiratory tract. In the 6 patients from whom serum samples were available, all had a 4-fold change in immunoglobulin (Ig) G titer and/or presence of IgM against CoV-HKU1. The 2 patients who died had significantly lower hemoglobin levels, monocyte counts, albumin levels, and oxygen saturation levels on admission and had more-extensive involvement visible on chest radiographs. Sequence analysis of the pol, S, and N genes revealed 2 genotypes of CoV-HKU1. Conclusions. CoV-HKU1 accounts for 2.4% of community-acquired pneumonia, with 2 genotypes in the study population. Without performance of diagnostic tests, the illness was clinically indistinguishable from other community-acquired pneumonia illnesses. © 2005 by the Infectious Diseases Society of America. All rights reserved.published_or_final_versio

Towards sustainable urban development: the social acceptability of high-rise buildings in a Ghanaian city

Over the years, many city managers, policy makers and academics alike have turned to high-rise buildings as pathway to sustainable urban development. However, the sustainability of such types of development in various geographical contexts, especially in sub-Saharan Africa, is a subject less explored. Amidst the promotion of high-rise development in a rapidly urbanizing metropolis in Ghana, Kumasi, the research empirically examined the social acceptability of high-rise residential facilities and the institutional capacity for their effective management. By conducting face-to-face interviews with sampled households, and critical public service providers in the metropolis, the study uncovered that, contrary to the evidence from many Asian cities, there is generally low social acceptability of high-rise developments, and a weak institutional capacity for effective service delivery. The research concludes that, whilst it is tempting to embrace high-rise buildings as sustainable development pathway, it is crucial they are pursued with much circumspection. In addition to their design being tailored to the local needs of the people for whom they are built, the promotion of high-rise development should recognize the importance of effective service delivery, and general social acceptability

Housing and the elderly in Singapore - financial and quality of life implications of ageing in place

In spite of the unprecedented success of publichousing in Singapore, the rapid rate at whichthe population is greying is causing housingstress in the matured Housing and DevelopmentBoard (HDB) estates. Although new housingoptions such as studio apartments are beingprovided by the public sector while a recentlyformed housing cooperative is developing aretirement village, the majority of the elderlyin Singapore prefer to age in place,notwithstanding the imbalance between thedemands of their homes and the functioninglevel of the elderly persons' physical andbiological systems. This implies that homemodification, rather than new-built elderlyhousing, may be a more pragmatic solution tothe elderly Singaporeans' housing problems thatcould also improve their quality of life. Since85% of the population of Singapore live inpublic housing, this paper examines the typesof home modifications that could be carried outto the existing stock of public housing so asto create a suitable living environment for theelderly. In addition, the paper considers thehousing finance predicaments of the elderlySingaporean and explores possible financinginstruments that could be implemented tosupport home modifications for Singapore'sgreying population. The paper concludes thatsince home modification(s) could improve thequality of life of the elderly persons morethan specialised housing, public funds shouldbe diverted from building new specialisedhousing to home modification(s) for elderlyhome owners

Distribution and molecular characterization of tetracycline resistance in Laribacter hongkongensis

Objectives: Laribacter hongkongensis is a newly discovered bacterium associated with gastroenteritis and found in freshwater fish. Although isolates resistant to tetracycline have been described, their resistance mechanisms have not been studied. Patients and methods: We describe the distribution and molecular characterization of tetracycline resistance in 48 L. hongkongensis isolates from humans and fish. Results: Three human isolates and one fish isolate were resistant to tetracycline (MIC 128 mg/L) and doxycycline (MIC 8-16 mg/L) and had reduced susceptibility to minocycline (MIC 1-4 mg/L). A 3566 bp gene cluster, which contains tetR and tetA, was cloned from one of the tetracycline-resistant strains, HLHK5. While the flanking regions and 3′ end of the tetA of HLHK5 were identical to the corresponding regions of a tetC island in Chlamydia suis, the tetA gene was almost identical to that of transposon Tn 1721 and plasmids of Gram-negative bacteria, suggesting that the tetA/tetR of HLHK5 may have arisen from illegitimate recombination. PCR and DNA sequencing showed the presence of tetA in the other three tetracycline-resistant L. hongkongensis strains. Sequencing and characterization of a 15 665 bp plasmid, pHLHK22, from strain HLHK22 revealed the presence of a similar tetA/tetR gene cluster. This novel plasmid also confers tetracycline resistance when transformed to Escherichia coli and other L. hongkongensis isolates. Conclusions: Horizontal transfer of genes, especially through Tn 1721 and related plasmids, is likely an important mechanism for acquisition and dissemination of tetracycline resistance in L. hongkongensis. The present study is the first report on identification of tetA genes in bacteria of the Neisseriaceae family. © The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.link_to_subscribed_fulltex

Susceptibility patterns of clinical and fish isolates of Laribacter hongkongensis: Comparison of the Etest, disc diffusion and broth microdilution methods

Objectives: To determine the antibiotic susceptibility patterns of 60 strains of Laribacter hongkongensis isolated from humans and fish to eight antibiotics and compare the results obtained from broth microdilution, Etest and disc diffusion susceptibility testing. Patients and methods: The susceptibilities of 60 isolates of L. hongkongensis from humans with gastroenteritis and fish to eight antibiotics were tested by three methods [broth microdilution (reference method), Etest and disc diffusion] and their results were compared. Results: All isolates were susceptible to imipenem and ciprofloxacin by all three methods, except for one strain which was resistant to ciprofloxacin by broth microdilution. All were susceptible to ampicillin/ sulbactam by Etest and disc diffusion, but eight were resistant by broth microdilution. By broth microdilution, 90%, 100%, 46.7%, 100% and 8.3% of isolates were resistant to ampicillin, ceftriaxone, cefuroxime, erythromycin and tetracycline, respectively. Although broth microdilution generally yielded higher MICs of β-lactams, MICs obtained with Etest were in good correlation with broth microdilution for all drugs except ampicillin/sulbactam, with >90% agreement within 2 log2 dilutions for imipenem, ciprofloxacin, erythromycin and tetracycline. Comparison of susceptibilities between broth microdilution and the other two methods showed the highest (>95%) percentage agreement for imipenem, ciprofloxacin and tetracycline. The highest discrepancies were observed with erythromycin (58.3% agreement), with an apparent increase in susceptibility by disc diffusion. A higher proportion of human isolates than fish isolates were tetracycline-resistant by all three tests (P = 0.022). Conclusions: Etest and disc diffusion appear to be reliable for evaluation of susceptibilities of L. hongkongensis to imipenem, ciprofloxacin and tetracycline. However, these methods may underestimate resistance to other β-lactams. © The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.link_to_subscribed_fulltex