Treatment response in HCV related chronic hepatitis

To evaluate the virological response to treatment with interferon and ribavirin in patients with hepatitis C related liver disease. Design: A descriptive study. Place and Duration of Study: January to September 2002 at Virology Department, Armed Forces Institute of Pathology Rawalpindi. Material and Two hundred seventy-nine patients were included in the study. These patients had taken interferon and ribavirin treatment for HCV related chronic hepatitis, and were referred to AFIP for HCV RNA testing by polymerase chain reaction [PCR] between January 2002 and September 2002. Out of 279 cases, 229 had taken the treatment for 06 or 12 months and were tested for end-of-treatment response [ETR]. Fifty patients had completed their treatment regimens of 6 or 12 months treatment, at least 24 weeks before their PCR test and were having follow-up testing for sustained viral response [SVR]. The sera of these patients were tested for HCV RNA by PCR, using a commercial kit of Amplicor [Roche] for qualitative detection of HCV RNA. Out of 229 cases tested for end-of-treatment response, 198 [86.5%] had no detectable HCV RNA [responders] and 31[13.5%] were PCR positive [non-responders]. Thirty-eight out of 50 cases, tested for a sustained viral response, had a negative result for HCV PCR thus showing sustained response rate of 76%. The viral remission/response to interferon and ribavirin combination therapy in our patients was better than that quoted in other regions

Hepatitis B in health care personnel

The exposure of health care personnel to blood, its products and carriers of Hepatitis B is much greater as compared to other segments of population. This study gives prevalence of past exposure and carrier state of HBV in health care personnel of our setup. It has been seen in our study that the nurses and laboratory workers are the worst affected. Two hundred and thirty one health care personnel [155 laboratory workers, 28 members of dental staff and 48 operation theatre staff] were tested for their ongoing HBV carrier state [HBsAg] and evidence for exposure to HBV in the past.Out of these 92 [39.8%] showed evidence of exposure to the virus in the past by being antiHBc positive.Out of the exposed persons 18 [7.7% of the total] were the HBsAg carriers and 61 [26.4%] had already developed immunity against the HBV by virtue of being anti-HBs positive

Drug resistance in mycobacterium tuberculosis: a four years experience

OBJECTIVE: To assess the prevalence of drug resistance amongst the clinical isolates of M. tuberculosis. SETTING: Armed Forces Institute of Pathology, Rawalpindi. METHOD: Four first line anti-tuberculosis drugs, isoniazid [INH], rifampicin [RIF], ethambutol [ETH] and streptomycin [STR] were tested on 300 isolates from clinical samples, by agar dilution method on Lowenstein Jensen medium. The sensitivities were interpreted by the resistance ratio method. One hundred and fifty eight [52.66%] isolates were found resistant to one drug at least. Among the resistant isolates, 79 [26.33%] were resistant to INH, 72 [24.0%] to RIF, 84 [28.0%] to STR and 70 [23.33%] to ETH with or without resistance to other drugs. Multi-drug resistance [MDR] was found in 41 isolates [13.66%]. To overcome this problem there is a need to establish centres at a number of places all over the country with professionals trained to handle the emerging problem of MDR. Each centre must be equipped with adequate facilities for susceptibility testing so that the resistance pattern can be ascertained and treatment regimens tailored accordingly

Detection of serum IgM against salmonella typhi: a rapid diagnostic technique

Typhoid fever is a serious problem in underdeveloped countries and is responsible for significant morbidity and mortality. Accurate diagnosis requires isolation of the typhoidal salmonella from blood and other body fluids, which is time consuming and such facilities are limited to a few major cities of Pakistan. Clinical features vary tremendously that makes clinical diagnosis difficult. Widal test is the most widely used investigation for the diagnosis of typhoid fever. However the test lacks sensitivity and specificity. Recently a new serological test called typhidot test based on the principle of enzyme immunoassay, developed by the Malaysian Bio Diagnostic Research [MBDR] has been introduced in Pakistan. The test aims at the detection of IgM and IgG specific for salmonella typhi in the patients serum. We evaluated this technique with a view to find out its sensitivity and specificity for the infections with S. typhi. Twenty five serum samples from patients with a culture positive typhoid infection and one hundred samples from patients who were divided into four groups two having a strong clinical suspicion of typhoid one febrile due to conditions other than typhoid and one comprising healthy adults were subjected to typhoid test. Results are very good with sensitivity and specificity well above 90%. The rapidity and specificity of this procedure for the diagnosis of typhoid fever justifies its cost

Alarming state of emerging resistance in salmonella typhi to conventional antityphoid drugs in the Kharian region

Enteric fever remains and important cause of mortality and morbidity in the under developed and the developing countries of the world. Once an illness of the hot weather, it is now endemic in Pakistan throughout the year. After the emergence of chloramphenicol [CAP] resistant Samonella typhi in Pakistan, this trend has been of the rise. In the Kharian region, about 93% of S. typhi are found resistant to conventional antityphoids [CAP, ampicillin and cotrimoxazole]. However, all the isolates remained susceptible to fluoroquinolones [ciprofloxacin and ofloxacin] and third generation cephalosporin [ceftriaxone] except S. paratyphi A which was uniformly sensitive to all the conventional antityphoids, fluoroquinolones and third generation cephalosporins

Cholera status at Rawalpindi/Islamabad, Pakistan

From 1947 to 1970, a number of cases of cholera occurred mainly in the East Wing of Pakistan. However, during this period and in subsequent years up to 1992, there were reports of sporadic cases of cholera in [West] Pakistan. In the year 1993, there was a sudden increase in the isolation rate of Vibrio cholerae 01 [71.65/1000 stool specimens] at Armed Forces Institute of Pathology [AFIP], Rawalpindi. However, the isolation rate of V.cholerae 01 again decreased [12.58/1000 stools specimens] during 1994. Fourteen isolates of V.cholerae non 01 were also obtained during these two years, but none of them was V.cholerae 0139. Tetracycline [TET] is no more the drug of choice for V.cholerae 01. There were 90.86% [n=169] and 90% [n=36] isolates of V.cholerae 01 resistant to TET during 1993 and 1994 respectively. However, doxcycline and minocycline were found very effective in vitro against V.cholerae 01. Ampicillin, cotrimoxazole and chloramphenicol resistance to V.cholerae 01 has increased significantly. All the V.cholerae 01 were uniformly sensitive to all the quinolones [nalidixic acid, enoxacin, ciprofloxacin and ofloxocin]. We must remain on guard against cholera through continuous surveillance as well as by assuring access to treatment and providing clean water and adequate sewage disposal

Changing pattern of prevalence and susceptibility of various urinary isolates in Rawalpindi / Islamabad

A number of 7585 microorganisms isolated from urine specimens between Jan 1989 and Dec 1993, at Armed Forces Institute of Pathology, Rawalpindi, were tested for their susceptibility to various antimicrobials. The disk diffusion technique [Kirby Bauer Method] using sensitest agar [Oxoid] [alone and/or with 5% horse blood] was adopted for various isolates against different antimicrobials. Escherichia coli remains the most common [46.96%] isolate, followed by pseudomonas aeruginosa [13.05%] and Klebsiella pneumoniae [12.99%]. There was no significant change in the rate of isolation of most of the organisms. However, there is decrease in isolation of Klebsiella pneumoniae from 1989 [20.07%] to 1993 [12.99%] and increase in isolation of Staphylococcus aureus [3.81% 9.80%] and streptococcus [Enterococcus] faecalis [0.55 to 4.81%]. Resistance of Escherichia coli against co-trimoxazole [COT] and ampicillin [AMP] has increased respectively from 40.32% and 39.65% [1989] to 76.18% and 77.98% [1993]. Resistance of Pseudomonas aeruginosa against ofloxacin [OFL] has increased from 46.3% [1989] to 60.83 h [1993]. Resistance of Klebsiella pneumoniae against nitrofurantoin [NIT] and norfloxacin [NOR] has increased respectively from 60% and 4.5% [1989] to 79.17% and 19.91% [1993]. Resistance of Staphylococcus aureus against AMP has increased from 86.85% [1989] to 95.09% [1993]. In 1993, all the isolates [excluding Pseudomonas aeruginosa and S. faecalis] revealed resistnace against NIT, 32.17% NOR, 20.31%; pipernedic acid, 37.19% COT, 78.68%; AMP, 86.83%; cephradine, 35.15%; gentamicin, 32.24%; OFL, 14.19% and ceftriaxone, 20.16%. It appears that AMP and COT should not be used empirically in urinary tract infection [UTI] and instead NIT or NOR may be preferred as empirical treatment of UTI

Cholera outbreak in 1993 at Rawalpindi and Islamabad

Seven pandemics of cholera have occurred since 1817; the seventh pandemic which started in 1961, n was caused by EITor biotype Vibrios. Until 1976, the antibiotic resistance was rare amongst the epidemic strains of cholera vibrios. They were sensitive to tetracycline [TET], chloramphenicol [CAP], ampicillin [AMP], gentamicin [GEIM] and nalidixic acid [IMAL]. The antimicrobial resistance was detected only in subsequent years. One hundred and seventy eight isolates of Vibrio cholerae serogroup O1, serotype Ogawa and biotype EITor from 1993 outbreak in Rawalpindi/Islamabad were tested for their susceptibility against various antimicrobials. Sensitivity was determined by disk diffusio method [Kirby Bauer] using Mueller-Hinton agar. Most of the strains were resistant to TET [91.0%], COT [91.0%] and CAP [80.3%]. However, only 6.5% and 3.3% of the strains were resistant to AMP and doxycycline [DOX]. Quinolones were found to be very effective in-vitro against all these isolates

guide to avail better service from clinical microbiology laboratory

Microbial diseases of different nature are one of the commonest problems faced by our nation including Armed Forces. The meager diagnostic resources for infectious diseases need appropriate utilization. The best out of the existing clinical microbiology laboratory services can be availed provided meticulous collection and transport of the samples is practiced and relevant clinical data is submitted

study of enteropathogenic microbial agents of diarrhoea disease in Rawalpindi/Islamabad areas

Acute diarrhoea has a world wide distribution and is one of the leading causes of morbidity and mortality in children in many developing countries. A total of 1200 stool specimens from the patients suffering from diarrhoea were analyzed for enteropathogenic microbial agents. A significant number [49.3%] revealed microbial agents as causative agent, while in 50.6% cases no pathogenic organism could be isolated. The main causative agents were bacteria [60.3%]. The viruses [21.96%] and parasites [17.74% contributed relatively less number of cases. Out of the bacterial pathogens, E. coli was the predominant organism 135 [37.81%] followed by Shigella spp, 87 [24.4%]. The Salmonella spp. constituted 79 [22.12%] and Vibrio app 40 [11.20%]. Out of the 105 parasite infected cases, Giardia lamblia comprised 95 [90.5%] followed by E. histolytica 10 [9.5%]. Among the viral causes, Rota virus was found in 130 [12.96%] of all diarrhoeal stools. The mixed infection due to enteropathogenic E. coli and Rota viruses was also found in a few children. Therefore we conclude that diarrhoneal diseases are prevalent in the population of Rawalpindi/Islamabad areas. Bacteria are the main causative agents as compared to viruses and parasites. The cause of diarrhoea should be established well before treatment and no diarrhoeal case should go undiagnosed

Bacteriological survey of drinking water in Rawalpindi and Islamabad

A total of 100 water samples from various sources, in and around Rawalpindi/Islamabad area, were assessed for bacterial contamination. Out of 100 samples, 43 untreated samples [100%] were contaminated, while out of 57 "chlorine treated" samples, 32 [56.2%] revealed the growth of coliform bacteria indicating faecal pollution of drinking water. The common organisms isolated were Escherichia coli; Klebsiella spp, Pseudomonas spp and Acinetobacter spp The Salmonella spp; Shigella spp; and Vibrio Cholerae were not found in any of the water samples. One sample of drinking water yielded the growth of an unidentified fungus. The water samples from springs [100%] and wells [91.67%] were found to be mostly contaminated