Antibiotic misuse contributes to the growing problem of microbial resistance. To understand the current knowledge and practices regarding antibiotic use among Syrians, we conducted a cross-sectional study of 430 randomly selected adult residents of Kalamoon in the Syrian Arab Republic using a questionnaire. A high proportion (85%) had taken antibiotics in the past 4 weeks and 34% were not aware of the dangers of antibiotics. Of 365 participants, only 43% were prescribed the antibiotic by a physician to treat the condition, while 57% used an old prescription or took someone else's advice. Males, younger individuals, and those with low and medium income and lower educational status showed poorer practice and lower knowledge towards antibiotics. Educational efforts are needed to reduce patient demand for antibiotics.

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To investigate whether cytokine responses may have a bearing on the symptoms and outcome of parvovirus B19 infection, circulating cytokines were measured during acute infection (n l 51), follow-up of acute infection (n l 39) and in normal healthy controls (n l 50). At acute B19 virus infection (serum anti-B19 IgM-positive), patients ranged in age from 4 to 54 years, with a mean age of 28n2 years. The male : female ratio was 1 : 4n1 and symptoms were rash (n l 15), arthralgia (n l 31), fatigue (n l 8), lymphadenopathy (n l 4), foetal hydrops (n l 3), transient aplastic crisis (n l 2), neutropenia (n l 2), myelodysplasia (n l 1), thrombocytopenia (n l 1) and pancytopenia (n l 1). Of these patients, 39 were contacted after a follow-up period of 2-37 months (mean of 22n5 months). In comparison with normal controls, detectable IL-6 was associated with acute B19 virus infection (26 % ; P l 0n0003), but not with follow-up (6 % ; P l 0n16). Detection of interferon (IFN)-γ was associated with acute B19 virus infection (67 % ; P 0n0001) and follow-up (67 % ; P 0n0001). Detection of tumour necrosis factor (TNF)-α was associated with acute B19 virus infection (49 % ; P 0n0001) and follow-up (56 % ; P 0n0001). IL-1β was detected in acute infection (20 %), but not at follow-up. At acute B19 virus infection, detection of serum/plasma IL-6 was associated with rheumatoid factor (P l 0n038) and IFN-γ ( 7 pg/ml) was associated with fatigue in those patients of 15 years of age (P l 0n022). At follow-up, fatigue was associated with IFN-γ ( 7 pg/ml) and/or TNF-α ( 40 pg/ml) (P l 0n0275). Prolonged upregulation of serum IFN-γ and TNF-α appears to represent a consistent host response to symptomatic B19 virus infection.

Objective: To review the clinical and pathological features of parvovirus B19 meningoencephalitis and its sequelae in 12 previously published cases, and to perform additional tests to determine the pathogenesis of the disease. Methods: Cases were reviewed and available serum and cerebrospinal fluid (CSF) tested for antiganglioside antibodies and a range of cytokines. In situ hybridisation for parvovirus B19 DNA was performed on postmortem brain tissue in two cases. HLA-DRB1 typing was undertaken on genomic DNA extracted from peripheral blood leucocytes. Results: Cerebellar involvement was suggested either clinically or pathologically in four cases. In the two cases with postmortem histology, there was marked atrophy of the molecular and granular layers of the cerebellum with focal loss of Purkinje cells. Brain scanning by MRI or CT was done in six cases during the acute phase. Three were abnormal with evidence of demyelination. Three had markedly enlarged ventricles, in two of which there was high signal intensity from the white matter on both T1 and T2 weighted images. The three cases with abnormal brain scans had long term neurological sequelae (mental retardation, personality change, altered affect). In situ hybridisation on available postmortem brain tissue was negative in the two cases tested. All cases in which HLA-DR alleles were determined carried at least one of the following alleles: HLA-DRB1*01, *04, *07, *09, *15, *16. Available serum and CSF was tested for antiganglioside antibodies (all negative) and for a panel of cytokines, which had a similar profile in both serum (n = 5) and CSF (n = 1) during the acute phase. Cytokines that were consistently detectable were IL-6 (mean 726.20 pg/ml), TNFα (50.64 pg/ml), IFNγ (39.64 pg/ml), GM-CSF (216.12 pg/ml), and MCP-1 (154.43 pg/ml); IL-1β, IL-5, and IL-13 were undetectable. Conclusions: HLA-DR associations, an increased cytokine response, and benefit from immunomodulatory treatment (in one case) support a role for the immune response in the pathogenesis of parvovirus B19 meningoencephalitis.

Parvovirus B19 has been linked with various clinical syndromes including neurological manifestations. However, its role in the latter remains not completely understood. Although the last 10 years witnessed a surge of case reports on B19-associated neurological aspects, the literature data remains scattered and heterogeneous, and epidemiological information on the incidence of B19-associated neurological aspects cannot be accurately extrapolated. The aim of this review is to identify the characteristics of cases of B19-associated neurological manifestations. A computerized systematic review of existing literature concerning cases of B19-related neurological aspects revealed 89 articles describing 129 patients; 79 (61.2%) were associated with CNS manifestations, 41 (31.8%) were associated with peripheral nervous system manifestations, and 9 (7.0%) were linked with myalgic encephalomyelitis. The majority of the cases (50/129) had encephalitis. Clinical characteristic features of these cases were analyzed, and possible pathological mechanisms were also described. In conclusion, B19 should be included in differential diagnosis of encephalitic syndromes of unknown etiology in all age groups. Diagnosis should rely on investigation of anti-B19 IgM antibodies and detection of B19 DNA in serum or CSF. Treatment of severe cases might benefit from a combined regime of intravenous immunoglobulins and steroids. To confirm these outcomes, goal-targeted studies are recommended to exactly identify epidemiological scenarios and explore potential pathogenic mechanisms of these complications. Performing retrospective and prospective and multicenter studies concerning B19 and neurological aspects in general, and B19 and encephalitic syndromes in particular, are required. © 2014 The Authors. Reviews in Medical Virology published by John Wiley & Sons, Ltd.