The number of cases of meningococcal disease reported to the Meningitis Reference Laboratory in Athens rose dramatically in 1996-1997. The aims were (1) to determine if the increase was due to introduction of new strains, (2) to assess the geographic and age distribution of the cases, (3) to compare antibiotic sensitivity patterns of the current isolates with strains from the early 1990s. In 1993-1994, 15/19 (74%) of the cases for which information on age was available were in children < or = 5 years; in 1995-1997, 80/179 (45%) of cases were in children < or = 5 years and 99 (55%) in the older age range (P < 0.02). From 593 cases in 1993 1997, 214 (36%) isolates were available for characterisation. Serogroup B was predominant in the early 1990s, but by 1997, serogroup C accounted for 46/72 (64%) of isolates and serogroup B for 25/72 (35%). Serogroup B was predominant in children < or = 5 years (44/78, 56%) but only 19/99 (18%) of older children and adults (P=0.0000005). Sulfonamide resistance decreased from 10/22 (45%) in 1993-1994 to 27/192 (14%) in 1995-1997 (P<0.01). Multilocus enzyme electrophoresis of 70 strains obtained during this period identified the epidemic ET-15 clone in 24 (34.3)%. The profiles of the Greek ET-15 isolates were identical to C:2a:P1.2(P1.5) strains responsible for the epidemic in the Czech Republic which began in 1993. This genotype was not found in Greek strains isolated prior to 1993. We conclude that the increase in meningococcal disease is due to introduction of the epidemic serogroup C:2a:P1.2(P1.5) strain responsible for disease in the Czech Republic and Canada.

The prevalence and patterns of Streptococcus pneumoniae resistance to antibiotics was examined in 146 nasopharyngeal carrier strains obtained during April and May, 1997, from 382 healthy children attending eight day care centers (DCCs) in the area of Athens. Reduced susceptibility to at least one antibiotic was found in 32.6% as follows: penicillin 11.4% (intermediate), cefotaxime 0.8% (intermediate), trimethoprim-sulfamethoxazole 22.7%, erythromycin 13.6%, tetracycline 11.4%, chloramphenicol 8.3%. Most of the nonsusceptible to penicillin isolates belonged to serogroups 23, 9, and 19. Multidrug resistance was detected in 11.4% of S. pneumoniae isolates including five penicillin nonsusceptible serogroup 23 strains. More than half of the multidrug resistant strains were susceptible to penicillin and belonged to serogroups 6 (4), 23 (1), 19 (1), and 1(1). Strains that belonged to the same serogroup/serotype and had identical resistance patterns appeared to cluster in some DCCs. Antibiotic use in the previous month was associated with reduced susceptibility to penicillin (p = 0.007) and multidrug resistance (p = 0.012). In conclusion, a moderate prevalence of reduced susceptibility to penicillin in pneumococcal carrier strains was found in our community. Multidrug resistance was common and was often associated with susceptibility to penicillin. Several distinct patterns of resistance were observed, suggesting the spread of resistant clones to our country.

A case of subconjunctival infection with a zoonotic species of Onchocerca is described, in a 16-year-old Albanian man who had immigrated to Greece. This is the first report of human infection with Onchocerca in this tissue location and only the eighth report of zoonotic Onchocerca in man.

In this study, the first such study in Greece, we used polyphasic identification combined with antifungal susceptibility study to analyze Aspergillus clinical isolates comprising 102 common and rare members of sections Fumigati, Flavi, Terrei, Nidulantes, Nigri, Circumdati, Versicolores, and Usti. High amphotericin B MICs (>2 g/ml) were found for 17.6% of strains. Itraconazole, posaconazole, and voriconazole MICs of >4 g/ml were shown in 1%, 5%, and 0% of the isolates, respectively. Anidulafungin, micafungin, and caspofungin minimum effective concentrations (MECs) of >2 g/ml were correspondingly recorded for 4%, 9%, and 33%, respectively, of the strains.

OBJECTIVE: To determine the distribution of serogroups/serotypes and antibiotic resistance pattern of Streptococcus pneumoniae isolated from pediatric infections in central Greece. METHODS: In total, 306 S. pneumoniae strains isolated from children, aged from 18 days to 14 years (median 18 months), during a 21-month period, from different specimen sources, were studied. Susceptibility testing was carried out by the Kirby---Bauer method and by the Etest, and serotyping by the Quellung reaction. RESULTS: Of the S. pneumoniae isolates, 3.9% were highly resistant to penicillin (PR), while 17.6% were intermediately resistant (IPR). PR and IPR isolates were found to be, in general, more resistant to other antibiotics than penicillin-susceptible isolates. The PR and IPR isolates belonged to the serogroup/serotypes 19, 23, 9, 6 and 14 (in descending order of frequency). The penicillin-susceptible isolates belonged to 20 different groups/serotypes, the most common being 19, 6, 14, 9, 3, 23 and 1 (in descending order of frequency). Serogroup 23 was often found to be multiresistant. CONCLUSIONS: Resistance to penicillin in S. pneumoniae isolates is relatively low and differs according to the specimen type. All the pneumococcal serogroups/serotypes isolated from the children were found to be included in the 23-valent polysaccharide vaccine. Most of the children with a pneumococcal infection, however, were less than 2 years old and could not be protected by the existing vaccine.