Seropositive HBsAg frequency in Karachi and interior Sindh, Pakistan

Viral hepatitis continues to be a major health problem in Pakistan which encourages appraisal of the current ferquency of HBV surface antigenemia. A total of 35,257 individuals of both sexes presenting at a private diagnostic lab and its branches in key areas of Karachi City were screened for HBsAg during an 8-year period ending June 30, 2006. Also evaluated were 1,776 blood samples collected from residents of Hyderabad, Khairpur, Larkana, Nawabshah, and Sukkur in Sindh province.Detection of HBsAg in all serum samples as a marker of HBV was done using the Roche COBAS CORE HBsAg-II EIA system. A total of 1,735 HBsAg positive cases [4.92%] were detected in those assessed in Karachi, and 39 [2.19%] in the individuals tested in parts of interior Sindh. The youngest seropositive subject was a male 3-month old infant, the eldest a 70-year old man; the majority of carriers [78.9%] were aged 16-49 years, and 70.8% of those testing positive in Karachi were male, as were 69.2% in other Sindh cities. HBsAg positivity in Karachi has steadily increased in frequency in our hands from 2.84% in 1998 to currently 4.92%. A significant majority of those positive in all age groups were male in gender warrants deliberation on the credible modes of infection, including homosexuality

Antibiotic options for enterococcus faecalis infections

Escalating resistance of enterococci to many antimicrobials poses a major therapeutic challenge; vancomycin-resistant enterococci [VRE], in particular, exhibit variation in resistance patterns, demanding tailored drug prescription. Hence we screened the in vitro sensitivity profiles of 112 local clinical isolates using 13 antibiotics for their possible therapy options biased by the site of infection. Specimens yielding enterococci referred by local hospitals [n=103] and private physicians [n=09] were processed during a two-year period ending September 2005 at Dr. Essa's Lab in Karachi, Pakistan. Consecutive Enterococcus faecalis strains cultured from urine [n=78], pus [n=18], blood [n=12], HVS [n=2] and ascitic fluid [n=2] were challenged in vitro with locally available antibiotics using the standard disc diffusion method; MICs of one VRE isolate were also performed. Vancomycin [99.1%] and teicoplanin [99.1%], followed by nitrofurantoin [97.3], fosfomycin [91.0%] and chloramphenicol [78.5%], were more effective than pipericillin-tazobactam [72.3%], ampicillin [54.4%], meropenem [45.5%] and ciprofloxacin [35.7%]. Gentamicin and cotrimoxazole offered ineffective zones of inhibition. Only a single VRE strain, also teicoplanin-resistant, was encountered. Increasing drug resistance of enterococci warrants concern and the search for possible therapeutic options prejudiced by local patterns of resistance and the site of infection. Vancomycin, teicoplanin, nitrofurantoin and chloramphenicol are also significantly effective on our current isolates and fosfomycin, typically considered a urinary drug, but encouraged by reports of its successful use in diverse sites, is discussed as a possible alternative

Suppurative otitis in Karachi: an audit of 510 cases

Suppurative disease of the middle ear is a constant challenge for otologists to treat. "Watchful waiting" may be acceptable for a few cases, but possibly all patients with chronic otitis media should receive antimicrobial therapy to minimize mastoid pathologies. Selection of a potentially effective drug, however, in the absence of discharge culture analysis, depends on the regional prevalent microflora. In a multicentre study of 596 consecutive ear-swab referrals processed during a 10-month period ending July 1997. Staph. aureus [40.4%] and Pesudomonas [29.6%] accounted for 70% of isolates among 10 bacterial species. Aspergillus [6.2%] and Candida [3.1%] were additional irritants. However, approximately 14.4% of swabs were culture-negative, suggesting possible other or non-infective aetiology. The finding that pseudomonas was increasingly implicated in recent months warrants tailored drug prescription; moreover, 37.9% of our Staph isolates were beta-lactamase producers and methicillin-resistant, necessitating the choice of "enzyme-stable" antibiotics for first-line use. The high number of gram-negative aerobes isolated from our cases of otitis media casts serious doubt on the role of the nasopharynx as the major contributor to this infective process; an alternate presumption that the faecal-aural route is often involved, seems more practical in our environment