Severe Human Infections Research Articles

Direct Synthesis of Dextran-Based Antibacterial Hydrogels for Extended Release of Biocides and Eradication of Topical Biofilms.

Cationic small molecular biocides have been developed as promising antibiofilm agents because of their tunability in chemical structures and their ability to disrupt established biofilms. However, the impact of biocides in antibiofilm treatment is largely limited due to the lack of an effective delivery system that can ensure sustained release of biocides at the target site. Herein we report a biocide-encapsulated antibacterial and antibiofilm hydrogel that acts as an efficient delivery vehicle for the biocide and eradicates matured bacterial biofilm. The hydrogels are prepared using dextran methacrylate (Dex-MA), a biocompatible and photopolymerizable polymer, and a nontoxic cationic biocide with two cationic charges, two nonpeptidic amide bonds, and optimized amphiphilicity, which is capable of eradicating established bacterial biofilms. The gels, prepared via direct loading of the biocide and with highly controllable amounts, display 100% activity against both drug-sensitive and drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA). Importantly, the gels are shown to release the biocide and kill bacteria for an extended period of time (until day 5). When being treated with the established bacterial biofilms, the released biocide from the gel is shown to completely eradicate establishedS. aureus, Escherichia coli, and MRSA biofilms, the most common biofilm forming bacteria that cause severe infections (e.g., skin infections, urinary tract infections, etc.) in humans. Moreover, the gels were shown to annihilate preformed MRSA biofilm with >99.99% bacterial reduction under in vitro and in vivo conditions in a superficial MRSA infection model in mice. Notably, when tested, excellent skin compatibility is observed for these materials in various animal models such as a rat model of acute dermal toxicity, guinea pig model of skin sensitization, and rabbit model of skin irritation. The biocompatible antibacterial and antibiofilm hydrogels developed herein thus might be useful in treating bacterial biofilm associated infections, especially topical infections.

A case of the severe human infection by avian influenza H7N9 was rescued successfully by the sepsis bundle

One confirmed diagnosis case of severe human infection by avian influenza H7N9 admitted to intensive care unit (ICU) of the Second Affiliated Hospital of Guizhou Medical University on January 12th, 2017 was reported. The patient was treated with the sepsis bundle, and recovered finally, including a series of comprehensive treatments, such as respiratory support, circulation support, antiviral, anti-inflammation, immunization enhancement, critical nursing, fluid management, nutritional support and treatment of complications. The critical patient was admitted on January 27th, and the treatment was successful. It has important significance to rescue the severe human infection from avian influenza H7N9 by the sepsis bundle.

A joint analysis of influenza-associated hospitalizations and mortality in Hong Kong, 1998\u20132013

Influenza viruses may cause severe human infections leading to hospitalization or death. Linear regression models were fitted to population-based data on hospitalizations and deaths. Surveillance data on influenza virus activity permitted inference on influenza-associated hospitalizations and deaths. The ratios of these estimates were used as a potential indicator of severity. Influenza was associated with 431 (95% CrI: 358–503) respiratory deaths and 12,700 (95% CrI: 11,700–13,700) respiratory hospitalizations per year. Majority of the excess deaths occurred in persons ≥65 y of age. The ratios of deaths to hospitalizations in adults ≥65 y were significantly higher for influenza A(H1N1) and A(H1N1)pdm09 compared to A(H3N2) and B. Substantial disease burden associated with influenza viruses were estimated in Hong Kong particularly among children and elderly in 1998–2013. Infections with influenza A(H1N1) was suggested to be more serious than A(H3N2) in older adults.

The antibiotic polymyxin B exhibits novel antifungal activity against Fusarium species.

The genus Fusarium comprises many species, including Fusarium oxysporum, Fusarium solani, Fusarium graminearum and Fusarium verticillioides, and causes severe infections in plants and humans. In clinical settings, Fusarium is the third most frequent mould to cause invasive fungal infections after Aspergillus and the Mucorales. F. solani and F. oxysporum are the most prevalent Fusarium spp. causing clinical disease. However, few effective antifungal drugs are available to treat human and plant Fusarium infections. The cationic peptide antibiotic polymyxin B (PMB) exhibits antifungal activity against the human fungal pathogens Candida albicans and Cryptococcus neoformans, but its efficacy against Fusarium spp. is unknown. In this study, the antifungal activity of PMB was tested against 12 Fusarium strains that infect humans and plants (banana, tomato, melon, pea, wheat and maize). PMB was fungicidal against all 12 Fusarium strains, with minimum fungicidal concentrations of 32 µg/mL or 64 µg/mL for most strains tested, as evidenced by broth dilution, methylene blue staining and XTT reduction assays. PMB can reduce the germination rates of conidia, but not chlamydospores, and can cause defects in cell membrane integrity in Fusarium strains. PMB exhibits synergistic activity with posaconazole and can potentiate the effect of fluconazole, voriconazole or amphotericin B against Fusarium spp. However, PMB does not show synergistic effects with fluconazole against Fusarium spp. as it does against Candida glabrata and C. neoformans, indicating evolutionary divergence of mechanisms between yeast pathogens and the filamentous fungus Fusarium.

Shikonin alleviates the biotoxicity produced by pneumococcal pneumolysin

AimsStreptococcus pneumoniae (S. pneumoniae) is a common pathogen that can cause severe infections in humans. Pneumolysin (PLY) is an important virulence trait of S. pneumoniae and has cytotoxicity, genotoxicity and pro-inflammatory activity; it is essential for the pathogenesis of S. pneumoniae pneumonia and is an anti-virulence target of small molecule drug development. The treatment options for this microbe were limit due to the ubiquitous antibiotic resistance; therefore, new drugs and treatment strategies are needed. MethodsShikonin was selected by drug screening based on haemolysis assays, and its mechanism of suppressing PLY toxicity was determined by oligomerization assay. Meanwhile, the in vitro cell viability assays and in vivo experiments were performed to explore the capability of shikonin to protect cells and tissue from S. pneumoniae-mediated damage. Key findingsShikonin was found to significantly decrease PLY-induced haemolytic activity, cytotoxicity and genotoxicity via lessening the formation of oligomers; moreover, the agent can reduce the mortality of mice caused by lethal pneumonia and mitigate the injury of target organs as well. SignificanceWe suggest that shikonin could be a potent candidate for a novel therapeutic or auxiliary substance in the treatment of infections encountering insufficient vaccines and antimicrobial resistance to traditional antibiotics.

M Gene Reassortment in H9N2 Influenza Virus Promotes Early Infection and Replication: Contribution to Rising Virus Prevalence in Chickens in China.

Segment reassortment and base mutagenesis of influenza A viruses are the primary routes to the rapid evolution of high-fitness virus genotypes. We recently described a predominant G57 genotype of avian H9N2 viruses that caused countrywide outbreaks in chickens in China during 2010 to 2013, which led to the zoonotic emergence of H7N9 viruses. One of the key features of the G57 genotype is the replacement of the earlier A/chicken/Beijing/1/1994 (BJ/94)-like M gene with the A/quail/Hong Kong/G1/1997 (G1)-like M gene of quail origin. We report here the functional significance of the G1-like M gene in H9N2 viruses in conferring increased infection severity and infectivity in primary chicken embryonic fibroblasts and chickens. H9N2 virus housing the G1-like M gene, in place of the BJ/94-like M gene, showed an early surge in viral mRNA and viral RNA (vRNA) transcription that was associated with enhanced viral protein production and with an early elevated release of progeny virus comprising largely spherical rather than filamentous virions. Importantly, H9N2 virus with the G1-like M gene conferred extrapulmonary virus spread in chickens. Five highly represented signature amino acid residues (37A, 95K, 224N, and 242N in the M1 protein and 21G in the M2 protein) encoded by the prevalent G1-like M gene were demonstrated to be prime contributors to enhanced infectivity. Therefore, the genetic evolution of the M gene in H9N2 virus increases reproductive virus fitness, indicating its contribution to the rising virus prevalence in chickens in China.IMPORTANCE We recently described the circulation of a dominant genotype (genotype G57) of H9N2 viruses in countrywide outbreaks in chickens in China, which was responsible, through reassortment, for the emergence of H7N9 viruses that cause severe human infections. A key feature of the genotype G57 H9N2 virus is the presence of the quail-origin G1-like M gene, which had replaced the earlier BJ/94-like M gene. We found that H9N2 virus with the G1-like M gene, but not the BJ/94-like M gene, showed an early surge in progeny virus production and more severe pathology and extrapulmonary virus spread in chickens. Five highly represented amino acid residues in the M1 and M2 proteins derived from the G1-like M gene were shown to mediate enhanced virus infectivity. These observations enhance what we currently know about the roles of reassortment and mutations in virus fitness and have implications for assessing the potential of variant influenza viruses that can cause a rising prevalence in chickens.

Staphylococcus aureus nasal carriage in health care workers: First report from a major public hospital in Argentina

Staphylococcus aureus causes numerous mild to severe infections in humans, both in health facilities and in the community. Patients and health care workers (HCWs) may disseminate strains during regular medical examinations or hospitalization. The aim of this study was to determine the nasal carriage rate of methicillin-susceptible and methicillin-resistant S. aureus among health care workers at Hospital Provincial del Centenario, a public general hospital in Rosario, Argentina. A transversal study was conducted on 320 health care workers. Nasal swabs were taken and presumptive S. aureus colonies were isolated. Bacterial identity and methicillin resistance status were confirmed by amplification of the nuc and mec genes. Chi square test and Fisher exact test were used for statistical analysis. Of 320 HCWs, 96 (30%) were nasal carriers of S. aureus, 20 of whom (6.3%) carried methicillin-resistant S. aureus (MRSA) and 76 (23.7%) methicillin-susceptible S. aureus (MSSA). Carriage was within thepublished values for physicians (30%) and higher for technicians (57%). Accompanying resistance (62/96, 64.6%) was detected, including resistance to fluoroquinolones (23/96, 24%), aminoglucosides (13/96, 13.5%) or to macrolides (33/96, 34.4%). All the strains were susceptible to vancomycin whereas only 3.1% (3/96), all of them on MSSA strains, were resistant to mupirocin. This study is the first one of its kind in Argentina and one of the few performed in South America, to highlight the relevance of nasal carriage of MRSA and MSSA in health care personnel and brings to light the need for consensus recommendations for regular S. aureus carriage screening as well as for decolonization strategies.

Development and transmission of antimicrobial resistance among Gram-negative bacteria in animals and their public health impact.

Gram-negative bacteria are known to cause severe infections in both humans and animals. Antimicrobial resistance (AMR) in Gram-negative bacteria is a major challenge in the treatment of clinical infections globally due to the propensity of these organisms to rapidly develop resistance against antimicrobials in use. In addition, Gram-negative bacteria possess highly efficient mechanisms through which the AMR can be disseminated between pathogenic and commensal bacteria of the same or different species. These unique traits of Gram-negative bacteria have resulted in evolution of Gram-negative bacterial strains demonstrating resistance to multiple classes of antimicrobials. The evergrowing resistance issue has not only resulted in limitation of treatment options but also led to increased treatment costs and mortality rates in humans and animals. With few or no new antimicrobials in production to combat severe life-threatening infections, AMR has been described as the one of the most severe, long-term threats to human health. Aside from overuse and misuse of antimicrobials in humans, another factor that has exacerbated the emergence of AMR in Gram-negative bacteria is the veterinary use of antimicrobials that belong to the same classes considered to be critically important for treating serious life-threatening infections in humans. Despite the fact that development of AMR dates back to before the introduction of antimicrobials, the recent surge in the resistance towards all available critically important antimicrobials has emerged as a major public health issue. This review thus focuses on discussing the development, transmission and public health impact of AMR in Gram-negative bacteria in animals.

Intensive Care Admissions for Children With Enterovirus and Human Parechovirus Infections in the United Kingdom and The Republic of Ireland, 2010-2014.

Enteroviruses and human parechoviruses usually cause mild, self-limiting illnesses in children but can occasionally cause severe disease. During 2010-2014, 104 children in the United Kingdom and the Republic of Ireland were admitted to a pediatric intensive care unit with severe enterovirus and human parechovirus infection; 40% had neurologic symptoms, 20% respiratory failure, 16% cardiac complications and 11% septic shock. Annual number of cases and incidence increased in the 5-year period, from 0.6/1000 pediatric intensive care unit admissions (12 cases) in 2010 to 1.8/1000 (36 cases) in 2014. Most cases (n = 86, 83%) were younger than 1 year; 77% (n = 80) required invasive ventilation, 40% (n = 42) inotropic support, 4% (n = 4) renal dialysis and 3% (n = 3) extracorporeal membrane oxygenation. Eight children (8%) died, including 4 with cardiac complications.

Severe Symptomatic Primary Human Cytomegalovirus Infection despite Effective Innate and Adaptive Immune Responses.

Primary human cytomegalovirus (HCMV) infection usually goes unnoticed, causing mild or no symptoms in immunocompetent individuals. However, some rare severe clinical cases have been reported without investigation of host immune responses or viral virulence. In the present study, we investigate for the first time phenotypic and functional features, together with gene expression profiles in immunocompetent adults experiencing a severe primary HCMV infection. Twenty primary HCMV-infected patients (PHIP) were enrolled, as well as 26 HCMV-seronegative and 39 HCMV-seropositive healthy controls. PHIP had extensive lymphocytosis marked by massive expansion of natural killer (NK) and T cell compartments. Interestingly, PHIP mounted efficient innate and adaptive immune responses with a deep HCMV imprint, revealed mainly by the expansion of NKG2C+ NK cells, CD16+ Vδ2(-) γδ T cells, and conventional HCMV-specific CD8+ T cells. The main effector lymphocytes were activated and displayed an early immune phenotype that developed toward a more mature differentiated status. We suggest that both massive lymphocytosis and excessive lymphocyte activation could contribute to massive cytokine production, known to mediate tissue damage observed in PHIP. Taken together, these findings bring new insights into the comprehensive understanding of immune mechanisms involved during primary HCMV infection in immunocompetent individuals.IMPORTANCE HCMV-specific immune responses have been extensively documented in immunocompromised patients and during in utero acquisition. While it usually goes unnoticed, some rare severe clinical cases of primary HCMV infection have been reported in immunocompetent patients. However, host immune responses or HCMV virulence in these patients has not so far been investigated. In the present study, we show massive expansion of NK and T cell compartments during the symptomatic stage of acute HCMV infection. The patients mounted efficient innate and adaptive immune responses with a deep HCMV imprint. The massive lymphocytosis could be the result of nonadapted or uncontrolled immune responses limiting the effectiveness of the specific responses mounted. Both massive lymphocytosis and excessive lymphocyte activation could contribute to massive cytokine production, known to mediate tissue damage. Furthermore, we cannot exclude a delayed immune response caused by immune escape established by HCMV strains.

Inhibition of influenza A virus infection by ginsenosides.

Influenza viruses cause mild to severe respiratory infections in humans. Due to efficient means of transmission, the viruses infect human population on a large scale. Apart from vaccines, antiviral drugs are used to control infection; neuraminidase inhibitors are thought to be the first choice of treatment, particularly for severe cases. Rapidly evolving and emerging influenza viruses with increased frequency of viral resistance to these drugs stress the need to explore novel antiviral compounds. In this study, we investigated antiviral activity of ginseng extract and ginsenosides, the ginseng-derived triterpene and saponin compounds, against 2009 pandemic H1N1 virus in vitro and in vivo. Our data showed that treatment of mice with ginsenosides protected the animals from lethal 2009 pandemic H1N1 infection and lowered viral titers in animal lungs. Mechanistic studies revealed that ginsenosides interact with viral hemagglutinin protein and prevent the attachment of virus with α 2–3’ sialic acid receptors present on host cell surfaces. The interference in the viral attachment process subsequently minimizes viral entry into the cells and decreases the severity of the viral infection. We also describe that sugar moieties present in ginsenosides are indispensible for their attachment with viral HA protein. On the basis of our observations, we can say that ginsenosides are promising candidates for the development of antiviral drugs for influenza viruses.

Exposure to β-lactams results in the alteration of penicillin-binding proteins in Clostridium perfringens

Clostridium perfringens causes a variety of mild to severe infections in humans and other animals. A decrease in the affinity of penicillin-binding protein (PBP) transpeptidases for β-lactams is considered one of the mechanisms of β-lactam resistance in bacteria. Two strains of C. perfringens isolated from bovines and one isolated from a chicken, which had decreased susceptibility to β-lactams, had variations in the amino acid sequences of the central penicillin-binding regions of the PBPs. β-Lactam-resistant mutants of another C. perfringens strain, ATCC 13124, were selected in vitro to determine the effects of exposure to β-lactams on the PBP genes. Cultures of the wild type rapidly developed resistance to penicillin G, cephalothin and ceftriaxone. The susceptibilities of all of the selected mutants to some other β-lactams also decreased. The largest PBP found in C. perfringens, CPF_2395, appeared to be the primary target of all three drugs. Strain resistant to penicillin G had mutation resulting in the substitution of one amino acid within the central penicillin-binding/transpeptidase domain, but the ceftrioxane and cephalothin-resistant strains had mutations resulting in the substitution of two amino acids in this region. The cephalothin-resistant mutant also had additional mutations in the CPF_0340 and CPF_2218 genes in this critical region. No other mutations were observed in the three other PBPs of the in vitro resistant mutants. Resistance development also altered the growth rate and cell morphology of the mutants, so in addition to the PBPs, some other genes, including regulatory genes, may have been affected during the interaction with β-lactam antibiotics. This is the first study showing the effects of β-lactam drugs on the substitution of amino acids in PBPs of C. perfringens and points to the need for studies to detect other unknown alterations affecting the physiology of resistant strains.

Thio- and Semicarbazones: Hope in the Search for Treatment of Leishmaniasis and Chagas Disease.

Trypanosomiasis and leishmaniasis cause severe infections in humans and domestic animals in the tropics. Although typical diseases in Latin America, globalization and the migration of infected people has spread these diseases to countries in North America, Asia and Europe. Currently available drugs are not effective in the chronic phase, as well as cause side effects and develop resistance. Among the chemical groups studied as potential anti-T. cruzi and anti-Leishmania are the thio-and semicarbazones, which are easy to obtain, possess structural versatility and can sequester metal. In this article, we present an overview of thio-and semicarbazones associated with heterocycles, indanones, and styryl and aryl skeletons, including their metal complexes with antimony, platinum, palladium, copper, ruthenium, rhenium, manganese and vanadium. Because of the efficiency and selectivity that some of these derivatives have shown, it can be concluded that thio-and semicarbazones constitute promising chemical scaffolds in the search for new anti-parasitic agents.

From Immunologically Archaic to Neoteric Glycovaccines.

Polysaccharides (PS) are present in the outermost surface of bacteria and readily come in contact with immune cells. They interact with specific antibodies, which in turn confer protection from infections. Vaccines with PS from pneumococci, meningococci, Haemophilus influenzae type b, and Salmonella typhi may be protective, although with the important constraint of failing to generate permanent immunological memory. This limitation has in part been circumvented by conjugating glycovaccines to proteins that stimulate T helper cells and facilitate the establishment of immunological memory. Currently, protection evoked by conjugated PS vaccines lasts for a few years. The same approach failed with PS from staphylococci, Streptococcus agalactiae, and Klebsiella. All those germs cause severe infections in humans and often develop resistance to antibiotic therapy. Thereby, prevention is of increasing importance to better control outbreaks. As only 23 of more than 90 pneumococcal serotypes and 4 of 13 clinically relevant Neisseria meningitidis serogroups are covered by available vaccines there is still tremendous clinical need for PS vaccines. This review focuses on glycovaccines and the immunological mechanisms for their success or failure. We discuss recent advances that may facilitate generation of high affinity anti-PS antibodies and confer specific immunity and long-lasting protection.

Identification and Detection of Serotype-Specific Genes: Effective Serotyping of Streptococcus suis

Purpose of review Streptococcus suis is an emerging zoonotic pathogen that can cause severe infections in pigs and humans. S. suis has been reported in Europe, America, and Asia, and has resulted in heavy losses to swine production and serious public health concerns. Serum agglutination has identified several serotypes. Here, we review the methods for serotyping S. suis, the current serological classifications, and the future trend in serotyping.

Draft Genome Sequences of Three Aeromonas hydrophila Isolates from Catfish and Tilapia.

ABSTRACTAeromonas hydrophila is a Gram-negative bacterium that is particularly adapted to freshwater environments and can cause severe infections in fish and humans. Here, we report the draft genomes of three A. hydrophila catfish and tilapia isolates.

Study of the Prevalence and Antimicrobial Susceptibility Patterns of Staphylococcus Aureus in Garhwal Region, India

Staphylococcus aureus is a ubiquitous commensal bacterium on human skins and anterior nares, but frequently causes severe infections in humans. It is commonest cause of infection in hospitals and is most liable to infect newborn babies, surgical patients, old and malnourished persons and patients with diabetes and other chronic diseases .Aim of this paper is to study the prevalence and detection of antimicrobial susceptibility patterns of Staphylococcus aureus at the Garhwal Region, India. Samples are collected from Veer Chandra Singh Government medical science and research institute HNB Base Hospital Srinagar Garhwal. Data obtained about the study subjects included basic demographics, reasons for admission, medical history(underlying diseases) , medication history, site of infection, culture site, social history and isolate characterization (e. g. antimicrobial susceptibility pattern results). P-value less than 0.05 were considered as statistically significant.During the two years period, 300 patients with clinical presentation of septicemia admitted in different units, namely Medicine, Nursery, Pediatrics, ICU, Orthopedic, Dialysis and Surgery, 309 of them were positive for S. aureus. The overall prevalence of S. aureus was 15.3% and the prevalence in the type of samples cultured were: blood (0.3%), followed by body fluids (12.4%), ear swabs (0.8%), FNAC (4.2%), PEDIA (3.5%), pleural fluid (4%), pus (0.8), pus aspirate (0.8), semen (28), sputum (0.8), urine (45.2%), vag (0.8%) and wound (2%). The sensitivity rates of the various antibiotics are as follows: ampicillin (16%), amoxicillin (39%), amikacin (86.3%), chiloroamhenicol (78.6%), cotrimoxazole (49.6%), cephoxitin/oxac (18.3%), ciprofloxacin (52.6%), eryhromycin (55.3%), gentamicin (70.6%), penicillin (5.3%), clindamycin (56.3%), rifampicin (38.4%), linezolid (41%), teicoplanin (46.3%) and vancomycin (48.6%). A total of 146 samples showed multi-resistance to antimicrobial antibiotics. Staphylococcus aureus isolates in this study showed higher multi-drug resistance patterns to several antimicrobials and thus further studies should be conducted in the hospital.

Crimean-Congo Hemorrhagic Fever: Report of Three Cases from Iran

Introduction: Crimean-Congo Haemorrhagic Fever (CCHF) is a viral haemorrhagic fever caused by RNA virus (Nairovirus -family: Bunyaviridae). CCHF can cause severe infection in humans with a fatality rate of up to 25%-30%. Typically sings are headache, agitation, high fever, mood instability, muscular pain, thrombocytopenia, leukopenia, leukocytosis, nosebleeds and black stools with 1-7 days' incubation period. Case Presentation: This study report Three human Crimean-Congo fever cases in Behbahan city in Khuzestan province of Iran MAY 2016. Conclusions: The main reasons for the transfer of CCHF in this cases, contact with contaminated meat, non-compliance with the rules relating to the slaughter, animal slaughter outside the slaughterhouse, the lack of sufficient monitoring of herds, lack of inspection of livestock and Insufficient education and awareness of the dangers diseases are zoonotic. Public education, respect for individual health issues and prevention against vector-borne diseases, can help to eliminate diseases such as CCHF.

Cellulose Acetate Based Material with Antibacterial Properties Created by Supercritical Solvent Impregnation

Supercritical CO2 was used as a green solvent and impregnation medium for loading cellulose acetate beads with carvacrol in order to obtain a biomaterial with antibacterial properties. Supercritical solvent impregnation was performed in a high-pressure view cell at temperature of 50°C and pressures of 10, 21, and 30 MPa with the processing time ranging from 2 to 18 h. The rate of impregnation increased with the pressure increase. However, maximum impregnation yield (round 60%) was not affected by the pressure applied. Selected samples of the impregnated cellulose acetate containing 6–60% of carvacrol were proven to have considerable antibacterial effect against Gram-positive and Gram-negative bacterial strains including methicillin-resistant Staphylococcus aureus which causes severe infections in humans and animals. In addition, cellulose acetate beads containing 6.0–33.6% of carvacrol were shown to have a porous structure with submicron pores which is of interest for the controlled delivery applications.

Systematic, active surveillance for Middle East respiratory syndrome coronavirus in camels in Egypt

Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe human infections and dromedary camels are considered an intermediary host. The dynamics of natural infection in camels are not well understood. Through systematic surveillance in Egypt, nasal, rectal, milk, urine and serum samples were collected from camels between June 2014 and February 2016. Locations included quarantines, markets, abattoirs, free-roaming herds and farmed breeding herds. The overall seroprevalence was 71% and RNA detection rate was 15%. Imported camels had higher seroprevalence (90% vs 61%) and higher RT-PCR detection rates (21% vs 12%) than locally raised camels. Juveniles had lower seroprevalence than adults (37% vs 82%) but similar RT-PCR detection rates (16% vs 15%). An outbreak in a breeding herd, showed that antibodies rapidly wane, that camels become re-infected, and that outbreaks in a herd are sustained for an extended time. Maternal antibodies titers were very low in calves regardless of the antibody titers of the mothers. Our results support the hypothesis that camels are a reservoir for MERS-CoV and that camel trade is an important route of introducing the virus into importing countries. Findings related to waning antibodies and re-infection have implications for camel vaccine development, disease management and zoonotic threat.Emerging Microbes & Infections (2017) 6, e1; doi:10.1038/emi.2016.130; published online 4 January 2017