ABSTRACT
Enteric fever is a potentially severe systemic febrile illness that is usually presented with non- specific symptoms and signs. Its diagnosis is usually confirmed by blood culture and stool culture besides the Widal agglutination test. The delayed results of microbiologic examination and the unreliable results of Widal test in endemic countries makes the search for a rapid and reliable method for diagnosis of typhoid fever more mandatory. This study aimed to compare the performance of the Enterocheck WB® test as a rapid serological test to that of the Widal test for diagnosis of typhoid fever in acute stage taking blood culture as the gold standard method. A total of 154 patients that had been clinically suspected as typhoid fever were investigated by the blood culture, Widal tube agglutination test and Enterocheck WB test in addition to 46 healthy controls were investigated by Widal tube agglutination test and Enterocheck WB test. Enterocheck WB® test showed higher sensitivity and specificity, 86% and 89% than Widal tube agglutination test, 81% and 71% respectively. Enterocheck test had higher sensitivity when fever duration <5 days [100%]. Enterocheck WB test is a useful, rapid easy serological test for early diagnosis of typhoid fever especially for primary healthcare centers and outpatient clinics as well as hospitals
ABSTRACT
Increasing numbers of elderly people are being treated in hospitals and are additionally at particular risk of acquiring nosocomial infections [Nl] with antibiotic-resistant organisms. Prevalence of Nl had been evaluated in this study in all inpatients in Geriatric Medicine Unit, EL Demerdash Hospital of Ain Shams University from March 2004 till September 2006. The association of Nl with intrinsic and extrinsic risk factors was also assessed, as well as the emergence of antibiotic resistant bacterial strains. All specimens were processed by routine methods and their antibiotic sensitivity was performed using the disc diffusion method in accordance with the Clinical and Laboratory Standards Institute [CLSI] guide lines. A total of 107 NIs were found among 100 of the 1202 hospitalized patients [prevalence 8.2% prevalence varied greatly from 3.3% in the internal ward to 14.2% in the ICU]. Respiratory tract as well as urinary tract infections was the most common NIs [43% each]. The most commonly isolated pathogens from ICU and the internal ward were Klebsiella spp.[25%], Candida spp.[12%], Pseudomonas aeruginosa [12%] and methicillin-resistant Staphylococcus aureus [MRSA] [9%]. They were followed by Escherichia coli and Enterobacter spp. [7.5% each], coagulase negative Staphylococci [6%] and Proteus spp. [5%]. Depending on infection site, the most frequent isolates were Klebsiella spp. [41%], MRSA [22%] for respiratory tract infection; Candida spp. [28%], Klebsiella pneumonie [15%], E.coli and Pseudomonas auruginosa [13% each] for urinary tract infection. Our results showed that 61.9% of studied patients with lower respiratory infections were due to endotracheal intubation and 95.2% of patients had urinary catheters and developed urinary tract infections. About 82.0% of the elderly patients were taking antibiotics, for at least 1 month prior to admission, which have contributed to the emergence of highly resistant pathogens among geriatric patients, including methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus spp., and multiple-drug-resistant Gram-negative bacilli and coagulase-negative staphylococcal strains. Colonization and infection with antibiotic resistant bacteria [ARB] is a rising menace in geriatric medicine. Establishing a surveillance system and developing an antibiotic policy provide the basis for antibiotic therapy and controlling antimicrobial resistance
Subject(s)
Humans , Male , Female , Cross Infection/etiology , Microbial Sensitivity Tests/methods , Aged , Geriatrics , Hospitals, University , Cross Infection/microbiologyABSTRACT
Pulmonary tuberculosis [TB] is a major cause of morbidity and mortality allover the world. Owing to the complex interaction between the Mycobacterium tuberculosis [MTB] and the specific host cell mediated immune response, the clinical spectrum of TB ranges from a few foci affecting the upper parts of the lungs to intense tissue destruction and caseous necrosis. TGF-beta is one of the inhibitory cytokines that, among other functions, is responsible for deactivation of the T-cell response that is important in host defense against MTB, suggesting its role in the pathogenesis of PTB.The aim of this study was to determine the serum level of TGF-beta1 in patients with active pulmonary tuberculosis [cavitary and non cavitary], in comparison to healthy controls and to chronic obstructive airway disease [COAD] patients as disease controls, as well as investigating the correlation between its level and disease severity. Tuberculous patients were followed up during the course of anti-tuberculous chemotherapy to assess the changes in TGF-beta1 level. Three groups were studied, including 24 pulmonary tuberculosis patients [9 patients were cavitary and 15 patients were non cavitary] that were selected according to the diagnostic standards and classification of tuberculosis. [New York NY: National Tuberculosis and Respiratory disease Association, 1969]. Twenty two patients with [COAD] were taken as a disease control group and 13 apparently healthy individuals with matching age and sex were included as normal controls. All patients were subjected to full history taking, clinical examination, laboratory diagnosis of TB by examination of sputum for the presence of acid fast bacilli [AFB] by film or culture and radiological diagnosis by chest X-rays. Serum from all patients and controls was examined for the level of TGF-beta1 using ELISA technique. Patients with PTB were followed up for the post treatment level of TGF-beta1 3 months after the onset of anti-tuberculous treatment. Statistical analysis for the results showed significant elevation of TGF-beta1 serum level in patients with PTB when compared to normal controls but not when compared to the disease controls. No significant difference was found between TGF-beta1 level on comparing the cavitary and non cavitary groups, or on comparing the pre and the post treatment levels. In conclusion TGF-beta1 is suggested to play an important role in the pathogenesis of pulmonary tuberculosis. Further studies can be done to evaluate the correlation between the TGF-beta1 level and the severity of tuberculous disease, or with the course of anti tuberculous treatment. Controlling TGF-beta1 production may be the key to prevent scarring and fibrosis in progressive pulmonary disease as tuberculosis and chronic obstructive pulmonary disease. Also using anti-TGF-beta1 antibodies may be promising anti-tuberculous agents with their anti-fibrotic actions that may prevent the progress of fibrosis during the course of the disease