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In Vitro Activity of Quinolones Against S

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In Vitro Activity of Quinolones Against S .lr...o_,:11 J.,,-!J �I U$.:I ..::.,L..,.�I !""l..Li:l fr-' -,I°J ,;yWI �I tJLJ.J..... _,:!.I J_r!J �)'I �I erJ.;..,.; Ji �)I �I �I 1,1° ..!,Ll.) _r),J -!.i�)il �l::iJ 4:,1\..i_,ll ..::.,\J.,J.IJ �l.il.lJ .-l}i/1 J�\;:JJ ,t.. �JjUIJ �I ..::.,l.,�I ij oJ.t..l..:1,.1 ..::.,IJ�W.IJ �I ..::.il.JSJIJ ,�I .:,t--11 .,1..,;a&.i JS'J! 4f>.'Y' -,/°J .J....._,:).1 Jr-�� lf.... � L., ,_1,:.J ,..::.it..._.,L.ll .;r �I �l_,J)'IJ ;_JWI L-.,.:Ji � C;' ..;Jl.dl _pl)IJ ,�I yp1 .r), ..::.,L..,li.;l\ i.1$'J ,�I .u.WI J\....J ,-1>.-Jb:-J �)'I ij �4 EASTERN MEDITERRANEAN HEALTH JOURNAL IS the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas, concepts, epidemiological data, research findings and other information, with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession, medical and other health educational institutes, interested NGOs, WHO Collaborating Centres and individuals within and outside the Region. LARE VUE DE SANTE DE LA MEDITERRANEE ORIENTALE EST une revue de sante officiellepubliee par le Bureau regional de \'Organisation mondiale de la Sante pour la Mediterranee orientale. Elle offre une tribune pour la presentation et la promotion de nouvelles politiques et initiatives dans le domaine des services de sante ainsi qu'a l'echange d'idees, de concepts, de donnees epidemiologiques, de resultats de recherches et d'autres informations, se rapportant plus particulierement a la Region de la Mediterranee orientale. Elle s'adresse a tous les professionnels de la sante, aux membres des instituts medicaux et autres instituts de formation medico-sanitaire, aux ONG, Centres collaborateurs de \'OMS et personnes concernes au sein et hors de la Region. The Eastern Mediterranean Health Journal is abstracted/indexed in the Index Medicus and MEDLIN£ (Medical Literature Analysis and Retrieval Systems on Line) and the ExtraMed-Full text on CD-ROM, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), CAB International, Lexis Nexis™ and the Index Medicus for the WHO Eastern Mediterranean Region (IMEMR). EMHJ is also available on the World Wide Web: http://wwwlemro.who.int/emhj.htm ALL ARTICLES ARE PEER REVIEWED ISSN 1020-3397 © WORLD HEALTH ORGANIZATION, 2005 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitations of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. The authors alone are responsible for the views expressed, which do not necessarily reflect the opinion of the World Health Organization or of its Member States. COVER: Remote sensing image of the area of the world that includes the Eastern Mediterranean Region. Cover image produced by the Canada Centre for Remote Sensing, Ottawa, Canada. (NOAA AVHRR Composite). Reproduced with permission. Cover designed by Ahmed Hassanein Printed on acid-free paper Printed by League of Arab States Printshop 6 La Revue de Santé de la Méditerranée orientale, Vol. 11, No 1/2, 2005 Cholera epidemic in Baghdad during 1999: clinical and bacteriological profile of hospitalized cases A.M. Al-Abbassi,1 S. Ahmed 2 and T. Al-Hadithi 2 ABSTRACT An epidemic of cholera in Iraq was anticipated for the year 1999 and a plan of notification and treatment of cases of diarrhoea was made. This paper documents the clinical and bacteriological profile of cholera cases admitted to the 6 hospitals in Baghdad during the epidemic. The number of stool culture- positive cases was 874. The peak incidence of cases (June 1999) was earlier than previous epidemics with no cases registered in November/December 1999. All age groups were affected and the case fatality rate was 1.3%. Strains isolated were Vibrio cholerae El-Tor O1, serotypes Ogawa (79.6%) and Inaba (12.1%), V. parahaemolyticus (2.0%) and non-agglutinable vibrios (6.1%). V. cholerae O139 was isolated from 2 cases (0.2%) for the first time in Iraq. Antibiotic resistance was noted, especially to tetracycline. Épidémie de choléra à Bagdad en 1999 : profil clinique et bactériologique des cas hospitalisés RÉSUMÉ Une épidémie de choléra en Iraq a été anticipée pour l’année 1999 et un plan a été établi pour la notification et le traitement des cas de diarrhée. Cet article documente le profil clinique et bactériologique des cas de choléra admis dans les six hôpitaux de Bagdad pendant l’épidémie. Le nombre de cas dont les cultures de selles étaient positives s’élevait à 874. Le pic d’incidence des cas (juin 1999) est survenu plus tôt que lors des épidémies précédentes, aucun cas n’ayant été enregistré en novembre/décembre 1999. Tous les groupes d’âge étaient touchés et le taux de létalité était de 1,3 %. Les souches isolées étaient Vibrio cholerae El Tor O1, sérotypes Ogawa (79,6 %) et Inaba (12,1 %), V. parahaemolyticus (2,0 %) et des vibrions non agglutinables (6,1 %). V. cholerae O139 a été isolé chez 2 cas (0,2 %) pour la première fois en Iraq. Une résistance aux antibiotiques a été constatée, en particulier à la tétracycline. 1Department of Medicine; 2Department of Community Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq (Correspondence to A.M. Al-Abbassi: [email protected]). Received: 26/06/02; accepted: 15/09/04 02 Cholera epidemic in Baghdad.pmd 6 10/25/2005, 1:20 AM Eastern Mediterranean Health Journal, Vol. 11, Nos 1/2, 2005 7 Introduction of deaths and many sectors of the city were completely depopulated [14]. The Cholera is a specific infectious disease of disease spread to Baghdad, with similar humans caused by Vibrio cholerae sero- consequences. After that, cholera contin- group O1and O139. It is an enzymatic pro- ued to appear in several epidemic forms cess causing a brief, acute onset diarrhoeal during the years 1871, 1889, 1894, 1899 illness, with recurrent vomiting and stools and 1917 [15], after which the disease that resemble rice water. This leads to completely disappeared from Iraq to reap- acute rapid dehydration with fluid and elec- pear again in August 1966 as a part of the trolyte loss, ending with acidosis and hypo- 7th pandemic spread [11,16]. After subsid- volaemic shock, which is usually fatal if ence of the 7th pandemic in Iraq, occasion- untreated [1–7]. Cholera spreads mainly al outbreaks of cholera continued in Iraq; via drinking water supplies contaminated Figure 1 shows the registered cholera cas- by human excreta, especially from sub- es in Iraq from 1991–99. However, there clinical carriers and mild cases. Humans was no official announcement of another are the reservoir of the disease, despite iso- epidemic until the year 1999. During 1991, lation of V. cholerae O1 from blue crabs a third of the total number of reported cas- [8] and from the faeces of some aquatic es were in Baghdad city (602) whereas in birds [9]. the inter-epidemic period 1990–98, Bagh- Cholera differs from other enteric dis- dad has a smaller proportion of the total eases in its clinical course (a very short in- (197). cubation period) and epidemic pattern After the escalation in the incidence of (rapidly spreading to different countries cholera cases in Iraq during 1998, and due and disappearing rapidly when outbreaks to serious shortages of safe water supplies subside) [10]. Cholera is endemic in Asia; for human use, the epidemic of cholera in from 1817 to 1923 there were 6 pandemic the year 1999 was anticipated. A plan of waves which moved through Asia then notification for cases of diarrhoea and their through the Americas and Africa [11–13]. treatment in general hospitals or isolation When the 3rd pandemic begun in 1852, it wards was arranged for a prospective extended to Persia, Mesopotamia and Eu- study. This paper documents the clinical rope as a whole. England was severely af- and bacteriological data of all cholera cases fected, allowing John Snow to complete admitted to the 6 hospitals in Baghdad dur- his studies of the relationship of the disease ing the epidemic of 1999 in Iraq. to water supplies at the Broad Street pump [11]. Throughout history, cholera has en- gendered fearful reactions; nowadays, out- Methods breaks often lead to inappropriate The 6 Baghdad hospitals chosen for the responses including trade embargoes, tour- management of diarrhoea cases during the ism restrictions, quarantine or excessive 1999 epidemic were the Medical City isolation and mass chemoprophylaxis. Teaching Hospital, Al-Mansour Paediatric Iraq is at risk of epidemics spreading Hospital, Ibn El-Khateeb Hospital for Infec- from neighbouring countries because it lies tions Diseases, the Central Paediatric Hos- on the routes of pilgrimage to Mecca and pital, Al-Kindy General Hospital and contains a number of holy shrines. During Al-Kadisia General Hospital. the epidemic of 1820, when cholera first spread to Basra, there were a great number 02 Cholera epidemic in Baghdad.pmd 7 10/25/2005, 1:20 AM 8 La Revue de Santé de la Méditerranée orientale, Vol.
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