Theimmunomodulatory effectsofantibioticscouldinfluencethedegreeofsystemicandlocalresponsestoinfection,soinvestigationoftheirintrinsicinfluenceonthehost’sinflammatoryresponseappearstobeessential.Fluoroquinolonesareknowntoexertmodulatoryactivityonimmuneresponsestomicrobialinfection.Howeverthemechanismofthisimmunmodulationhasnotbeenwellelucidated.Theaimofthework,istoassesstheimmunomodulatoryeffectsofalevofloxacin,throughexaminingitseffectontheconcentrationsoftumornecrosisfactorα(TNF-α)andInterleukin–10(IL-10)inserumofpneumonicpatients.Afterfollowinglocalresearchethicscommitteeapprovalandinformedconsent.Thisstudyincluded 40patientswithdifferenttypesofpneumonia,admittedtodepartmentofChestDiseases,FacultyofMedicine,AssiutUniversityHospitals,Egypt.Also,10healthyvolunteersservedasrandomizedcontrols.Bothpatientsandcontrolsreceivedlevofloxacin(750mgoncedailyfor10days).SerumlevelsofTNF-αandIL-10weremeasuredinpatientsandcontrolbeforeandafterlevofloxacinadministration(750mgoncedailyfor10days)usinghumanTNF–αandIL-10ELISAkitsrespectively.LevofloxacincausedastatisticallysignificantdecreaseinthemeanlevelofTNF-αinbothpatients(20.82±1.31pg/ml)(P0.009)andcontrolgroup(17.12±0.84pg/ml)(P0.004).Incontrast,therewasstatisticallysignificantincrease(P0.000)inthemeanlevelofIL-10inpatients (61.75±2.85pg/ml)whilestatisticallysignificantdecrease(P0.005)incontrolgroup(28.57±1.37pg/ml).Inconclusion,ourstudydemonstratesthattreatmentwithlevofloxacinaffectsproductionofTNF-αasapro-inflammatorycytokineandIL-10asananti-inflammatorycytokineswhichmayprovide additionalbenefitsintreatmentof respiratorytract infectionsthatare independentofitsantibacterialproperties.

ABSTRACT Community-acquiredpneumoniaisacommondiseaseandafrequentcauseofmorbidityandmortalityworldwide.HaemophilusinfluenzaeisaleadingcauseofCAP.ThecurrentstudywasconductedtodeterminetheserotypedistributionandantimicrobialsusceptibilitypatternsofHaemophilusinfluenzaeisolatedfromunvaccinatedadultpatientswithCAPatAssiutUniversityHospitals.MaterialsandMethods:FromSeptember2013toaugust2014,sputumsamplesfrom132adultpatientswithCAPwereanalyzedforthedetectionofHaemophilusinfluenzausingconventionalmethods.AntimicrobialsusceptibilityandserotypingofHaemophilusinfluenzaewasperformed.Results:Haemophilusinfluenzaeweredetectedin21(16%)CAP-patients.Non-typeableHinfluenzaewerethemostfrequentlyisolatedserotypethatfoundin15(71%)ofHinfluenzae-cases.Hinfluenzaetypebwasfoundin5(24%)cases.WhileHinfluenzaetypefwasfoundinone(5%)case.CasesweredetectedmainlyduringJanuary,February,andMarch.ResistancewashighestfortheB-lactamgroupofantibiotics.Conclusion:CAPhasadiseaseburdeninadultpatientsatAssiutUniversityHospitals,Egypt.HinfluenzaeisaleadingcauseofCAPwhichwasassociatedmostlywithnon-typeableserotypes.ResistancetopenicillinandotherantimicrobialagentsincreasedrapidlyduringthelastyearsamongH influenzaestrains. Keywords:Haemophilusinfluenzae,community-acquiredpneumonia,serotyping, antimicrobialresistance.

ABSTRACT Community-acquiredpneumoniaisacommondiseaseandafrequentcauseofmorbidityandmortalityworldwide.HaemophilusinfluenzaeisaleadingcauseofCAP.ThecurrentstudywasconductedtodeterminetheserotypedistributionandantimicrobialsusceptibilitypatternsofHaemophilusinfluenzaeisolatedfromunvaccinatedadultpatientswithCAPatAssiutUniversityHospitals.MaterialsandMethods:FromSeptember2013toaugust2014,sputumsamplesfrom132adultpatientswithCAPwereanalyzedforthedetectionofHaemophilusinfluenzausingconventionalmethods.AntimicrobialsusceptibilityandserotypingofHaemophilusinfluenzaewasperformed.Results:Haemophilusinfluenzaeweredetectedin21(16%)CAP-patients.Non-typeableHinfluenzaewerethemostfrequentlyisolatedserotypethatfoundin15(71%)ofHinfluenzae-cases.Hinfluenzaetypebwasfoundin5(24%)cases.WhileHinfluenzaetypefwasfoundinone(5%)case.CasesweredetectedmainlyduringJanuary,February,andMarch.ResistancewashighestfortheB-lactamgroupofantibiotics.Conclusion:CAPhasadiseaseburdeninadultpatientsatAssiutUniversityHospitals,Egypt.HinfluenzaeisaleadingcauseofCAPwhichwasassociatedmostlywithnon-typeableserotypes.ResistancetopenicillinandotherantimicrobialagentsincreasedrapidlyduringthelastyearsamongH influenzaestrains. Keywords:Haemophilusinfluenzae,community-acquiredpneumonia,serotyping, antimicrobialresistance.

ABSTRACT Community-acquiredpneumoniaisacommondiseaseandafrequentcauseofmorbidityandmortalityworldwide.HaemophilusinfluenzaeisaleadingcauseofCAP.ThecurrentstudywasconductedtodeterminetheserotypedistributionandantimicrobialsusceptibilitypatternsofHaemophilusinfluenzaeisolatedfromunvaccinatedadultpatientswithCAPatAssiutUniversityHospitals.MaterialsandMethods:FromSeptember2013toaugust2014,sputumsamplesfrom132adultpatientswithCAPwereanalyzedforthedetectionofHaemophilusinfluenzausingconventionalmethods.AntimicrobialsusceptibilityandserotypingofHaemophilusinfluenzaewasperformed.Results:Haemophilusinfluenzaeweredetectedin21(16%)CAP-patients.Non-typeableHinfluenzaewerethemostfrequentlyisolatedserotypethatfoundin15(71%)ofHinfluenzae-cases.Hinfluenzaetypebwasfoundin5(24%)cases.WhileHinfluenzaetypefwasfoundinone(5%)case.CasesweredetectedmainlyduringJanuary,February,andMarch.ResistancewashighestfortheB-lactamgroupofantibiotics.Conclusion:CAPhasadiseaseburdeninadultpatientsatAssiutUniversityHospitals,Egypt.HinfluenzaeisaleadingcauseofCAPwhichwasassociatedmostlywithnon-typeableserotypes.ResistancetopenicillinandotherantimicrobialagentsincreasedrapidlyduringthelastyearsamongH influenzaestrains. Keywords:Haemophilusinfluenzae,community-acquiredpneumonia,serotyping, antimicrobialresistance.

ABSTRACT Community-acquiredpneumoniaisacommondiseaseandafrequentcauseofmorbidityandmortalityworldwide.Streptococcuspneumoniaeisthemostcommoncauseofcommunity-acquiredpneumonia. ThecurrentstudywasconductedtodeterminetheserotypedistributionandantimicrobialsusceptibilitypatternsofStreptococcuspneumoniaeisolatedfrompatientswithcommunity-acquiredpneumoniaatAssiutUniversityHospitals.FromFebruary2013toMay2013,sputumsamplesfrom60adultpatientswithcommunity-acquiredpneumoniawereanalyzedforbacterialetiologyusingconventionalmethods.Antimicrobialsusceptibility and serotyping of Streptococcuspneumoniae wasperformed. bacterialagentsweredetectedin53patients(88%).Streptococcuspneumoniaewasthemostcommon(30%)isolatedbacteria.Eightco-infectionswereidentified.Thedetectedpneumococcal-serotypeswereindecreasingorder;1,9V,6B,19F,23F,14,and19A.Pneumococcal-antibioticresistancewashighestforpenicillinandampicillinantibiotics.Streptococcuspneumoniaeisthemostcommonisolatedbacteriaincasesofcommunity-acquiredpneumoniawhichisassociatedwithcertainserotypes.Resistancetopenicillinandotherantimicrobialagentsincreasedrapidlyduringthelastyearsamongpneumococcalstrainsworldwide. Keywords:Streptococcuspneumoniae,community-acquiredpneumonia,serotyping,antimicrobialresistance.

ABSTRACT Community-acquiredpneumoniaisacommondiseaseandafrequentcauseofmorbidityandmortalityworldwide.Streptococcuspneumoniaeisthemostcommoncauseofcommunity-acquiredpneumonia. ThecurrentstudywasconductedtodeterminetheserotypedistributionandantimicrobialsusceptibilitypatternsofStreptococcuspneumoniaeisolatedfrompatientswithcommunity-acquiredpneumoniaatAssiutUniversityHospitals.FromFebruary2013toMay2013,sputumsamplesfrom60adultpatientswithcommunity-acquiredpneumoniawereanalyzedforbacterialetiologyusingconventionalmethods.Antimicrobialsusceptibility and serotyping of Streptococcuspneumoniae wasperformed. bacterialagentsweredetectedin53patients(88%).Streptococcuspneumoniaewasthemostcommon(30%)isolatedbacteria.Eightco-infectionswereidentified.Thedetectedpneumococcal-serotypeswereindecreasingorder;1,9V,6B,19F,23F,14,and19A.Pneumococcal-antibioticresistancewashighestforpenicillinandampicillinantibiotics.Streptococcuspneumoniaeisthemostcommonisolatedbacteriaincasesofcommunity-acquiredpneumoniawhichisassociatedwithcertainserotypes.Resistancetopenicillinandotherantimicrobialagentsincreasedrapidlyduringthelastyearsamongpneumococcalstrainsworldwide. Keywords:Streptococcuspneumoniae,community-acquiredpneumonia,serotyping,antimicrobialresistance.

Themajorityofchronicobstructivepulmonarydiseaseexacerbationsarecausedbyinfectionsofthetracheobronchialtree.PreviousdataonbacterialexacerbationsofCOPDinUpperEgyptarelimited.Hence,thisstudywasconductedfortheidentificationofthecausativebacteriainexacerbationsofCOPD,andtoillustratetheirantimicrobialsusceptibilitypatternsatAssiutUniversityHospitals,UpperEgypt.Atotalof116COPDpatientswhounderwent167infectionexacerbationattacksparticipatedinthisprospectivestudy during2013.Significantbacterialgrowthwasfoundin143(86%)out ofthe167 exacerbationattacks.Themostcommondetected bacteriawereHaemophilusinfluenzae(19.4%),Escherichiacoli(18%),Streptococcuspneumoniae(16.7%),Klebsiellapneumoniae(14%),Streptococcuspyogenes(10%),Pseudomonasaeruginosa(5.6%),methicillinresistantStaphylococcusaureus(5.6%),Acinetobacter baumannii(4.2%),andMoraxellacatarrhalis(2.8%).The majority of theisolatedstrainsshowedhighresistanceratesto mostgroupsofantibioticswhere91(63%) oftheisolated strainswere multidrug resistant, 37(26%)strainswereextremedrugresistantand16(11%) bacterialstrainswerepandrugresistant.Highresistancerateswereobservedagainstpenicillinsandcephalosporins.Moderateresistanceratesweredetectedagainstthefluoroquinolones.Highsusceptibilitiesweredetectedtothecarbapenemgroup.AlltheisolatedGram-positivebacteriaweresensitivetolinezolid

Themajorityofchronicobstructivepulmonarydiseaseexacerbationsarecausedbyinfectionsofthetracheobronchialtree.PreviousdataonbacterialexacerbationsofCOPDinUpperEgyptarelimited.Hence,thisstudywasconductedfortheidentificationofthecausativebacteriainexacerbationsofCOPD,andtoillustratetheirantimicrobialsusceptibilitypatternsatAssiutUniversityHospitals,UpperEgypt.Atotalof116COPDpatientswhounderwent167infectionexacerbationattacksparticipatedinthisprospectivestudy during2013.Significantbacterialgrowthwasfoundin143(86%)out ofthe167 exacerbationattacks.Themostcommondetected bacteriawereHaemophilusinfluenzae(19.4%),Escherichiacoli(18%),Streptococcuspneumoniae(16.7%),Klebsiellapneumoniae(14%),Streptococcuspyogenes(10%),Pseudomonasaeruginosa(5.6%),methicillinresistantStaphylococcusaureus(5.6%),Acinetobacter baumannii(4.2%),andMoraxellacatarrhalis(2.8%).The majority of theisolatedstrainsshowedhighresistanceratesto mostgroupsofantibioticswhere91(63%) oftheisolated strainswere multidrug resistant, 37(26%)strainswereextremedrugresistantand16(11%) bacterialstrainswerepandrugresistant.Highresistancerateswereobservedagainstpenicillinsandcephalosporins.Moderateresistanceratesweredetectedagainstthefluoroquinolones.Highsusceptibilitiesweredetectedtothecarbapenemgroup.AlltheisolatedGram-positivebacteriaweresensitivetolinezolid

Themajorityofchronicobstructivepulmonarydiseaseexacerbationsarecausedbyinfectionsofthetracheobronchialtree.PreviousdataonbacterialexacerbationsofCOPDinUpperEgyptarelimited.Hence,thisstudywasconductedfortheidentificationofthecausativebacteriainexacerbationsofCOPD,andtoillustratetheirantimicrobialsusceptibilitypatternsatAssiutUniversityHospitals,UpperEgypt.Atotalof116COPDpatientswhounderwent167infectionexacerbationattacksparticipatedinthisprospectivestudy during2013.Significantbacterialgrowthwasfoundin143(86%)out ofthe167 exacerbationattacks.Themostcommondetected bacteriawereHaemophilusinfluenzae(19.4%),Escherichiacoli(18%),Streptococcuspneumoniae(16.7%),Klebsiellapneumoniae(14%),Streptococcuspyogenes(10%),Pseudomonasaeruginosa(5.6%),methicillinresistantStaphylococcusaureus(5.6%),Acinetobacter baumannii(4.2%),andMoraxellacatarrhalis(2.8%).The majority of theisolatedstrainsshowedhighresistanceratesto mostgroupsofantibioticswhere91(63%) oftheisolated strainswere multidrug resistant, 37(26%)strainswereextremedrugresistantand16(11%) bacterialstrainswerepandrugresistant.Highresistancerateswereobservedagainstpenicillinsandcephalosporins.Moderateresistanceratesweredetectedagainstthefluoroquinolones.Highsusceptibilitiesweredetectedtothecarbapenemgroup.AlltheisolatedGram-positivebacteriaweresensitivetolinezolid

Abstract Allovahlkampfiaspelaeawasidentifiedforthefirsttimein2009.Asafreelivingamoeba,ithasbeensuggested tobeaprotectivehostforsomebacterialpathogensagainstharshenvironmentalconditionsandcantransmitthem tovulnerablehosts.WeaimedinthisstudytotesttheinteractionsbetweenAllovahlkampfiaspelaeaandsomewaterborneandfoodbornebacteriaandunravelifthetestedbacteriacansurviveandmultiplyinsideamoeba.WeusedakeratitisisolateofAllovahlkampfiaspelaeagrowninPYGmediumcontainingproteosepeptone,yeast extracts,andglucose.WeexaminedamoebainteractionswithMethicillinresistantStaphylococcusaureus,Escherichiacoli1,Klebsiellapneumoniae,Enterobacteraerogenes,Citrobactercloaca,Proteusmirabilis,Raoultella terrigena,Raoultellaornitholytica,AeromonashydrophilaandPseudomonasaeruginosausingtheco-culture assays.Amoebalsurvivalratewithdifferentbacterialstrainsweredetermined.WiththeexceptionofProteusmirabilisthatshoweddecreasedsurvivalratesinsideamoebalcells,otherbacterialisolatescouldsurviveand multiplyinsideAllovahlkampfiaspelaeathatwasassociatedwithdecreasedsurvivalratesoftheamoeba. Particularly,Pseudomonasaeruginosa,AeromonashydrophilaandMRSAexhibitedsignificantlyincreasedmultiplicationratesinsideamoeba.OurstudydemonstratedthatAllovahlkampfiaspelaeamayactasareplicative host for pathogenic bacteria with environmental and clinical implications.