DNA microarray for identification of fungal pathogens causing invasive fungal infections [IFIs] in neutropenic patients

Opportunistic invasive fungal infections [IFIs] remain as important cause of morbidity and mortality. Candida and Aspergillus species are the most common fungi that cause disease in immunocompromised patients and transplant recipients. This study was designed to identify Candida and AspergilIus spp. as possible causes of IFIs in neutropenic patients with different hematological diseases, using high multiplexing capacity of DNA microarray [species identification array]. Twenty eight patients admitted to Hematology unit-Ain Shams University Hospitals with provisional diagnosis of lFl were enrolled in this study. Venous blood samples were collected to detect Candida and Aspergillus spp. using DNA microarray. Nineteen out of 28 studied patients [67.9%] were infected with Candida and Aspergillus spp. Invasive aspergillosis constituted 13/19[68.4%] distributed as follows: A.fumigatus 6/19 [31.6%], A.flavus 4/19 [21%] and A.niger 3/19 [15.8%]. On the other hand, Fl with Candida spp. constituted 6/19 [31.6%] distributed as follows; C.glabrata 3/19 [15.8%], C.tropicalis 2/19 [10.5%] and C.albicans 1/19 [5.3%]. Duration of hospital stay [mean +/- SD = 30.8 +/- 4 days] was statistically significant among the infected group in comparison to other patients [mean +/- SD = 22.7 +/- 2.3 days]. Nineteen out of 28 studied patients [67.9%] were infected with Candida and Aspergillus spp. Invasive aspergillosis constituted 13/19 [68.4%], while Candidal infection constituted 6/19 [31.6%]. DNA microarray represents a reliable method of potential use in clinical laboratories for parallel one-shot detection and identification of the most common fungal pathogens at the species level for prompt management of infection with tailored antifungal treatments

Nosocomial urinary tract infection in intensive care unit patients

Catheter related nosocomial urinary tract infection is considered as one of the most important hospital acquired infections. This study was designed to determine the causative organisms causing catheter associated urinary tract infection in ICU patients as well to test the pattern of the antimicrobial sensitivity of the isolated organisms. Sixty patients admitted to ICUs in Ain Shams University Hospitals over the period from February to August 2007, were enrolled in this study. A significant urinary viable count >/= 10[3] CFU/ml was revealed from 37 cases, comprising 61.7%. On the other hand, fourteen patients [23.3%] provided insignificant count and nine [15%] showed no growth. Candida was the most common isolated organism 45.7% of all isolates followed by Enterococci 18.8%, Klebsiella pneumoniae spp 16.9%, thereafter E.coli, Pseudomonas aeruginosa and Enterobacter cloaca 4.2%, each. Proteus mirabilis, Providencia stuartii and Acinetrobacter baumannii were the least isolated organisms 2%. All Enterococci isolates were highly sensitive to norfloxacin followed by gentamicin, streptomycin, vancomysin and nitrofurantoin, respectively, and were highly resistant to ampicillin, and 22.2% of isolates were resistant to vancomycin. Klebsiella pneumoniae isolates were highly sensitive to cefotaxime-calvulonic acid, ceftazidime-clavulonic acid and imipenem followed by amikacin and were highly resistant to ampicillin, ciprofloxacin, norfloxacin, ticarcillin and piperacillin followed by amoxicillin-clavulonic acid, cephalothin, cefuroxime and azteronam and then cefotaxime, ceftazidime, gentamicin, nalidixic acid and nitrofurantoin. Isolates of E.coli were sensitive to ciprofloxacin, norfloxacin, nalidixic acid, nitrofurantoin, imipenem and amikacin but resistant to ampicllin, ticarcillin and tetracycline. Isolates of Pseudomonas aeruginosa were resistant to most antimicrobials except gentamicin and aztreonam. The incidence of extended spectrum beta-lactamse production by the Gram-negative bacilli was 41.1%. Seventy five percent of Klebsiella pneumoniae isolates were ESbetaL producers. The duration of catheterization was considered as an important risk factor for catheter related nosocomial urinary tract infection and there was higher prevalence of infection among cases with catheter duration more than 4 days

Prevalence of SEN virus [SEN-V] infection among patients on maintenance hemodialysis in Egypt

Several lines of evidence have suggested the existence of new hepatitis agents, in addition to established hepatitis viruses A-E. before 1990, 10%-20% of patients with both transfusionassociated and community-acquired hepatitis tested were negative for known hepatitis viruses. Recently, a new family of single-stranded DNA viruses with hepatotropic properties was isolated and designated as SEN virus [SEN-V], after the initials of the infected patient. SEN virus isolates are genetically heterogenous and likely are members of TTV family Circoviridae. SEN virus-D and H [SENV-D,H] are most closely associated with transfusion-associated non AE hepatitis. High prevalence rates have been documented in patients undergoing surgery and/or blood transfusion and in patients had immunodeficiencies, sexually transmitted diseases, autoimmune disorders, HIV infections or who were injection drug users. The aim of this study was to determine the prevalence of SEN virus infection in hemodialysis patients and in unpaid blood donors and comparing it to the prevalence of HBV and HCV infection, find out any possible association between SEN virus and HBV or HCV in hemodialysis patients. This study was conducted on 55 patients from hemodialysis unit, Ain Shams University hospitals and 25 unpaid blood donors as a control group. Serum samples were collected from all patients and controls and tested for alanine aminotransferase level [ALT]], HCV-Ab and HBsAg by ELISA, HCV-RNA by PCR for positive HCV-Ab cases and controls and SEN-V DNA by seminested polymerase chain reaction [PCR]. The present study detected SEN virus in 89.1% [49 out of 55] patients on hemodialysis versus 16% [4 out of 25] controls. The SENV-H was detected in a higher prevalence than SENV-D among both cases and controls as +ve SENV-H/SENV-D were 36/13 in cases while they were 3/1 in controls. We also detected high prevalence of HBsAg among cases +ve for SENV-H 31.3% while HCVAb and HCV RNA "detected by PCR" were more prevalent among SENV-D +ve cases "66.7% and 55.6% respectively". There was no statistically significant relation between SEN-V positivity and mean level of ALT or AST. We concluded that infection by SEN-V was not associated with clinical or biochemical signs of liver disease, even among HBV or HCV infected patients SEN-V infection was not linked with enhanced severity of hepatitis. So, at present, we do not regard it as necessary to dialyse SEN-V viremic patients on separate machines. Additional studies are needed to assess the medical importance of SENV infection

Changes in vaginal microflora and bone resorbing cytokines level in postmenopausal period

This study was designed to evaluate the role of postmenopausal estrogen deficiency on vaginal microflora, detect its relation with level of bone resorbing cytokines and to evaluate their role in postmenopausal osteoporosis. One hundred and twenty females were investigated. They were divided into two groups, Group I included 60 women in postmenopausal period, Group II [control group] included 60 women in premenopausal period. All of them were subjected to bacteriological examination: vaginal swabs were used for making direct Gram-stained smears but only 100 specimens [50 from each group] were cultured on suitable culture media to isolate different vaginal microorganisms and compare the isolates of the two tested groups. Eighty females [40 from each group] were subjected to serological studies including estimation of serum level of interleukin-6, interleukin- 1 beta, and tumor necrosis factor-alpha] using enzyme immunoassay [EIA] technique, estradiol and osteocalcin levels were measured by radioimmunoassay [RIA] technique. The study revealed that vaginal flora in postmenopausal females, according to Nugent Scoring System, showed normal pattern [82%] Intermediate [15%] and bacterial vaginosis [3%] compared with 72%, 23% and 5% respectively in premenopausal females with no statistically significant difference between the two groups [P>0.05]. There was a lower isolation rate of facultative Lactobacilli, Gardnerella vaginalis, C and ida albicans and Mobiluncus in postmenopausal females than in premenopausal females. Catalase +ve Lactobacilli was found to be predominant over catalase -ve in both post- and premenopausal females although their rate of isolation was lower in premenopausal females. In most of the cases, which showed bacterial vaginosis, G. vaginalis were isolated in high percentage associated with catalase-ve Lactobacilli. There was higher level of estradiol in sera of premenopausal than in postmenopausal females with statistically significant difference between them [P<0.001]. Serum level of osteocalcin was elevated in post- than in premenopausal females with no statistically significant difference between them [P>0.05]. There was also no statistically significant correlation between osteocalcin and age, parity, body mass index and estradiol level. A higher serum level of IL-6 and TNF-alpha was found in post- than in premenopausal females with statistically significant difference between them [P 0.05]. These factors showed no statistically significant correlation with serum level of both estradiol and osteocalcin [P>0.05]. Estrogen replacement therapy is recommended for postmenopausal females with more attention must be paid to personal hygienic measures for protection against colonization of vagina with potentially pathogenic microorganisms. Moreover, detection of bone resorbing cytokines level in bone microenvironment together with their estimation in serum are more important tool to evaluate the role of postmenopausal estrogen deficiency on bone resorption