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Overview

Generalities
Agents Several agents:
 
1) Bacteria:
- Neisseria meningitides (meningococcus): the serotypes responsible of invasive infection are A, B, C, W135, Y, X
- Haemophilus influenza: there are 6 serotypes from (a) to (f). The serotype (b) is responsible of invasive infection
- Streptococcus pneumonia (pneumococcus): there are more than 90 serotypes
- Other bacterial agents: listeria, staphylococcus, enteric bacteria, group B streptococci, tuberculosis …
 
2) Virus:
- Mumps
- Measles
- West Nile virus: a flavivirus
- Enterovirus: including Coxsackieviruses A (1-11, 14, 16-18, 22, 24), Coxsackieviruses B (1-6), Echoviruses (1-7, 9-23, 25, 27, 30-33), Enterovirus 71, Poliovirus (1-3)
- Herpes Simplex virus: with 2 types 1 and 2
- Varicella / Chicken-pox: Human (alpha) herpesvirus 3 (varicella-zoster) from the group Herpesvirus
- Adenovirus: Adenovirus, several types (1, 2, 3, 4, 5 and 7), genus Mastadenovirus, family Adenoviridae,
- Lymphocytic choriomeningitis: lymphocytic choriomeningitis virus (arenavirus)
- Sandfly fever viruses: genus phlebovirus, family Bunyaviridae. They include more than 60 antigenically distinct virus serotypes. Two main groups are identified: the sandfly fever group including the Naples serocomplex (Karimabad virus, Arabia virus, Massilia virus, Punique virus, Tehran virus, Toscana virus …) and Sicilian serocomplex; and the Uukuniemi group.
-Other virus: arboviruses…
 
3) Parasites and fungi:
- Leptospirosis: Spirochetes, Leptospira interrogans  (25 serogroups)
- Other:  Candida albicans, cryptococcal, syphilis …
Incubation The incubation varies with the agent.
 
Agent Incubation
Bacteria  
Neisseria meningitidis 3-4 days (2-10 days)
Haemophilus influenza 2-4 days
Streptococcus pneumoniae 1-4 days
Listeria monocytogenes 3-70 days (median of 3 weeks)
Virus  
West Nile virus 3-12 days
Enterovirus 7-14 days (2-35 days)
Herpes 2-12 days
Varicella / Chicken-pox 2-3 weeks
Lymphocytic choriomeningitis virus 8-13 days (15-21 days for meningitis)
Adenovirus 1-10 days
Sandfly fever viruses 3-4 days (up to 6 days)
Parasites and Mycoses  
Leptospira 2-30 days (10 days)
 
 
 
Period of communicability The period of communicability varies with the agent.
 
Agent Period of communicability
Bacteria  
Neisseria meningitidis From onset and up to 24 hours after starting antibiotherapy that has effective concentrations in nasopharynx.
Haemophilus influenza From onset and up to 24-48 hours of starting effective antibiotherapy.
Streptococcus pneumoniae As long as the bacteria is present in the upper respiratory tract.
Listeria monocytogenes - Mothers of infected newborns can shed the bacteria in vaginal discharges and urine 7-0 days after delivery
- Infected patients can shed the bacteria in stool for several months
Virus  
West Nile virus No person-to-person transmission.
Enterovirus - Virus excreted in stools for several weeks
- Virus excreted in pharynx for the first 2 weeks post infection
Herpes 2-7 weeks after skin lesions onset.
Varicella / Chicken-pox 2 days before until the skin lesions are crusted (5 days).
Lymphocytic choriomeningitis virus No person to person transmission.
Adenovirus Shortly prior to and for the duration of the active disease
Sandfly fever viruses Virus present in blood of infected patients 1 day before and 1 day after onset of illness.
Parasites and Mycoses  
Leptospira Excreted in urine for 1 month
 
 
Reservoir The reservoir varies with the agent.
 
Agent Reservoir
Bacteria  
Neisseria meningitidis Humans
Haemophilus influenza Humans
Streptococcus pneumoniae Humans, possible carriage.
Listeria monocytogenes Soil, forage, water, mud and silage.
Virus  
West Nile virus Birds
Enterovirus Humans
Herpes Humans
Varicella / Chicken-pox Humans
Lymphocytic choriomeningitis virus House mouse (Mus musculus), hamster colonies. The mouse excretes the virus in saliva, feces and urine.
Adenovirus Humans
Sandfly fever viruses Humans, rodents.
Parasites and Mycoses  
Leptospira Wild and domestic animals
 
 
Modes of transmission The modes of transmission vary with the agent.
 
Agent Modes of transmission
Bacteria  
Neisseria meningitidis Person to person transmission: direct contact with droplet, nasal and throat discharge
Haemophilus influenza Person to person transmission: direct contact with respiratory, nasal and throat discharge.
Streptococcus pneumoniae Person to person transmission: direct contact with respiratory discharge
Listeria monocytogenes - Food-borne: ingestion of raw or contaminated milk, soft cheese vegetables and ready-to-eat meats (Pate)
- Direct contact with infectious material
- Neonatal: from mother to fetus or from mother to newborn (through the infected birth canal)
- Nosocomial transmission in nursery: via contaminated equipment or material
Virus  
West Nile virus Bite by infected mosquitoes (Culex sp, or Anophele sp)
Enterovirus - Person-to-person:
- Fecal-oral
- Contact with respiratory secretions
- Contact with conjunctival secretions
- Contaminated water / swimming pools
- Flies
Herpes - Person-to-person:
- Contact with saliva
- Sexual contact
- Soiled hands
- Neonatal (infected birth canal)
Varicella / Chicken-pox - Person-to-person:
- Contact with droplets
- Contact with vesicle fluid
- Indirect contact
- Airborne
Lymphocytic choriomeningitis virus - Airborne: contaminated dust
- Food-borne: ingestion of contaminated food
- Direct contact: skin contamination or cuts
Adenovirus - Person-to-person:
- Fecal-oral route
- Respiratory transmission
- Inoculation with conjunctival secretions
- Nosocomial
- Contaminated water and swimming pools
Sandfly fever viruses Bite of infective phlebotomine (Phlebotomus papatasi, P. perfiliewi , P. perniciosus, P. major sensu lato )
Parasites and Mycoses  
Leptospira - Contact with abraded skin or mucous membranes with soil, vegetation, contaminated with urine of infected animals or contaminated water
- Direct contact with urine or tissues of infected animals
- Ingestion of food or water contaminated with urine of infected animals
 
 
Clinical The symptoms vary with the agent.
 
Agent Clinical picture
Bacteria  
Neisseria meningitidis Meningitis, septicaemia
Haemophilus influenza Meningitis, epiglottitis, pneumonia …
Streptococcus pneumoniae Meningitis, pneumonia, septicaemia
Listeria monocytogenes  
Virus  
West Nile virus - Usually asymptomatic.
- Complication: meningitis and encephalitis
Enterovirus - Asymptomatic,
- Gastro-enteritis, flu-like illness, aseptic meningitis, paralysis
Herpes - Gingivostomatitis (type1), genital infection (type 2)
- Complications: meningoencephalitis
- Reactivation is possible
Varicella / Chicken-pox - Skin eruption: first maculo-papular then vesicular.
- Complications: pneumonia, hemorrhage, meningoencephalitis
Lymphocytic choriomeningitis virus - Influenza-like illness.
- Complications: meningitis, parotiditis, arthritis, myocarditis…
Adenovirus - Epidemic herato-conjunctivitis, gastro-enteritis, pharyngo-conjunctival fever, acute respiratory infection
- Complications: meningoencephalitis
Sandfly fever viruses - Usually self-limited disease: fever, myalgia, headache, photophobia …
- Complications: Aseptic meningitis and meningoencephalitis (Toscana),
Parasites and Mycoses  
Leptospira Rash, hemolytic anemia, hemorrhage, hepato-renal failure, mental confusion, myocarditis…
 
 
Worldwide  
Agent Profil
Bacteria  
Neisseria meningitidis Endemic in the African meninigitis belt (from Senegal to Ethiopa)
Haemophilus influenza Worldwide under 5 years
Streptococcus pneumoniae Worldwide
Listeria monocytogenes Worldwide
Virus  
West Nile virus Widespread in Africa, Middle East, North America, India.
 
Enterovirus Worldwide
Herpes Worldwide
Varicella / Chicken-pox Worldwide
Lymphocytic choriomeningitis virus America, Europe.
Adenovirus Worldwide
Sandfly fever viruses In Mediterranean counties, Europe and Middle East
Parasites and Mycoses  
Leptospirose Worldwide
 
 
Lebanon The annual average of reported cases of meningitis is 192.
Among them, meningitis due to Neisseria meningitis occurs with 6 (2-12) cases per year.
Among them, meningitis due to Haemophilus influenza occurs with 1 (0-2) cases per year.
Among them, meningitis due to Streptococcus pneumoniae occurs with 19 (16-21) cases per year.
 
Control objective Control
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All
ATC Name B/G Ingredients Dosage Form Price
C01CA03 ? NORADRENALINE G Norepinephrine tartrate - 8mg/4ml 8mg/4ml Injectable solution 330,201 L.L
A04AA01 ? ONDANSETRON USP G Ondansetron - 8mg/4ml 8mg/4ml Injectable solution 447,948 L.L
N02BE01 ? PARACETAMOL G Paracetamol - 1g/100ml 1g/100ml Injectable solution 191,978 L.L
N03AB02 ? PHENYTOIN SODIUM 5% USP G Phenytoin (sodium) - 250mg/5ml 5ml Injectable solution 276,448 L.L
V03AB35 ? SUGAMMADEX G Sugammadex - 200mg/2ml 100mg/ml Injectable solution 5,214,109 L.L
D10BA01 A-CNOTREN G Isotretinoin - 20mg 20mg Capsule, soft gelatin 1,526,524 L.L
D10AD01 A-RET G Tretinoin - 0.05% 0.05% Cream 335,961 L.L
N02BE51 A.B.C.-COLD G Paracetamol - 500mg, Chlorphenamine maleate - 4mg, Phenylephrine HCl - 5mg Tablet, film coated 534,977 L.L
B01AC06 A.S HEART G Acetylsalicylic acid - 81mg 81mg Tablet, enteric coated 148,463 L.L
N05AX12 ABILIFY MAINTENA B Aripiprazole - 400mg 400mg Injectable powder for suspension, prolonged release+solvent 29,491,998 L.L
N05AX12 ABIPREX 10 G Aripiprazole - 10mg 10mg Tablet 1,075,074 L.L
N05AX12 ABIPREX 15 G Aripiprazole - 15mg 15mg Tablet 1,075,074 L.L
L02BX03 ABIRATERONE ACETATE NEAPOLIS G Abiraterone acetate - 250mg 250mg Tablet 75,418,662 L.L
L02BX03 ABIRATERONE ACETATE SPC G Abiraterone acetate - 250mg 250mg Tablet, film coated 73,748,373 L.L
L02BX03 ABLAX 250 G Abiraterone acetate - 250mg 250mg Tablet 45,056,853 L.L
L02BX03 ABLAX 250 G Abiraterone acetate - 250mg 250mg Tablet L.L
L02BX03 ABLAX 500 G Abiraterone acetate - 500mg 500mg Tablet 45,056,853 L.L
L02BX03 ABLAX 500 G Abiraterone acetate - 500mg 500mg Tablet L.L
L01CD01 ABRAXANE BioTech Paclitaxel Albumin- bound - 5mg/ml 5mg/ml Injectable powder for dispersion 17,850,751 L.L
L02BX03 ABREMIA G Abiraterone acetate - 250mg 250mg Tablet 77,478,802 L.L
L02BX03 ABREMIA G Abiraterone acetate - 250mg 250mg Tablet L.L
L04AB04 ABRILADA BioTech Adalimumab - 40mg 40mg Injectable solution 40,259,574 L.L
L04AB04 ABRILADA BioTech Adalimumab - 40mg 40mg Injectable solution 40,259,574 L.L
J07BX05 ABRYSVO B RSV subgroup A stabilized perfusion F antigen 60mcg - 60mcg, RSV subgroup B stabilized perfusion F antigen 60mcg - 60mcg, Glycoprotein F stabilized in the perfusion conformation - Injectable powder + solvent 22,650,721 L.L
D10BA01 ABSORICA LIDOSE G Isotretinoin - 16mg 16mg Capsule, hard 1,827,045 L.L
N02AB03 ABSTRAL B Fentanyl (citrate) - 200mcg 200mcg Tablet 5,261,143 L.L
N02AB03 ABSTRAL B Fentanyl (citrate) - 100mcg 100mcg Tablet 3,419,743 L.L
N07BB03 ACAMPROSATE BIOGARAN G Acamprosate - 333mg 333mg Tablet, gastroresistant 3,641,813 L.L
V01AA ACARIZAX 12 SQ-HDM ORAL LYOPHILISATE B Allergen extracts - 12 SQ-HDM Tablet, lyophilised 9,366,451 L.L
R05CB01 ACC LONG G N-acetylcysteine - 600mg, Vitamin C - 75mg 600mg Tablet, effervescent 286,238 L.L
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