ABSTRACT
Background: P.stuartii has emerged as an important nosocomial pathogen affecting primarily the hospitalized patients especially those with long term indwelling urinary catheters. Bladder colonization with those organisms provides a reservoir for outbreaks in long term care facilities. P.stuartii as an opportunistic pathogen is occasionally implicated in other types of hospital acquired infections, it could be isolated from infected wounds and burns. P. stuartii is of great clinical importance because of this organism's broad spectrum resistance to antibiotics, as clinical strains of P.stuartii are commonly resistant to aminopenicillins and early generation cephalosporins due to the production of an inherent Ambler class C cephlosporinase [AmpC], it can also acquires plasmide encoding class A Extended Spectrum Beta Lactamases [ESBLs]. Infection caused by ESBL producing P.stuarttii and its difficult treatment is a real emerging problem that should be really estimated in our locality. Aim : The aims of this study 'were to isolate P. stuartii from different sites of infection among patients in Mansoura University Hospitals [MUH], detect ESBL-producing Multi Durg Resistant [MDR] P. stuartii strains and confirm its role as nosocomial pathogen and to Identify of risk group patients and their clinical outcome. Methods: Urine, blood, sputum and -wound specimens were collected from patients clinically suspected of nosocomial infections. The collected specimens were cultivated on blood agar, MacConkey agar, chocolate agar and CLED agar for urine specimens. P.stuartii isolates were identified by colonial morphology, gram stained films, biochemical reactions and they were confirmed by API 20E strips. Double disk synergy test was performed to detect ESBLs producing isolates and MDR isolates were identified using the minimum inhibitory concentration [MIC] Etest strips. Finally the ESBLs producing MDR P.stuartii isolates were further characterized as regarded AmpC production using the modified three dimensional test and the presence of bla CTX-M gene by polymerase chain reaction. Results: P.stuartii was detected in 32 samples, representing 4.3% of all nosocomial pathogens. Most of the isolates were from catheterized urine samples and the most isolated co-pathogen was Proteus species. P.stuartii infections were significantly higher in patients with age more than 60 years [59.4%]. 53.1% of the isolated P. stuartii were ESBL-MDR isolates, 94% of them were AmpC producer and 65% of them were PCR positive for bla CTX-M gene. Conclusion: the clear role of P.stuartii as nosocomial pathogens, the high morbidity and mortality associated with their infections and their MDR character, make accurate detection is very important in order to offer successful treatment and ensure better patient outcome?
ABSTRACT
Background: the persistence of hepatitis B virus [HBV] DNA in liver tissue or serum in the absence of detectable hepatitis B surface antigen [HBsAg] is called occult hepatitis B infection [OBJ]. Both HBV and hepatitis C virus [HCV] are transmitted parenterally, and coinfection is not uncommon, particularly in countries with a high prevalence of one or both viruses
Aim: this study was conducted to assess OBI prevalence in Egyptian patients with HCV related liver diseases, see if anti-HBc alone can. consider a good marker for detection of OBI, to record the serological profile of occult HB V infected patients, and to detect the clinical impact of this coinfection
Methods: after exclusion of HBsAg positive patients, serum samples from 128 Egyptian patients with HCV related liver diseases were included in our study. All the patients were positive for anti-HCV and HCV RNA, and negative for HBsAg. Serum samples were collected and subjected to fiver function tests and virological assays for HBsAg,
Results: occult HBV infection was detected in 21% of our patients with the highest prevalence found in patients with hepatocellular carcinoma [HCC] [44.4%] followed by patients with cirrhosis [22.2%] then chronic hepatitis C patients [16.3%]. Occult HBV infection can be found in both patients who show previous hepatitis B infection, [22%], and in those who were negative for anti-HBc, [19%]. Occult HBV infection was detected with the highest prevalence in patients with anti-HBc only [51.8%], followed by patients with negative all serological markers [29.6%], then [11.1%] were anti-HBc and anti-HBs, and finally [7.4%] were anti-HBc and anti. HBe. Patients co-infected with occult hepatitis B had significantly a higher prevalence of sever fibrosis [12/27 OBJ versus 13/101 HCV only infected patient, P<0.01] and significantly higher prevalence of decompensated liver disease [3/4 OBJ versus 3/14 HCV only infected patient, P<0.05]
Conclusion: OBJ is highly prevalent in Egypt. It is frequently associated with HCV-related chronic liver diseases and it may play a major role as an etiological agent for hepatocellular carcinoma in these patients. Occult HBV infection may have a clinical significance as it may increase the liver fibrosis and worsen the liver disease in HCV patients but we think that it doesn't affect the HCV response to combination therapy
ABSTRACT
Egypt has a very high prevalence of Hepatitis virus type C [HCV] infection and an increasing incidence of hepatocellular carcinoma [HCC] in a younger age group. As alcoholism is rare in Egypt, the main risk factor for carcinogenesis in HCV infected patients is supposed to be mutation induced by aflatoxin or its metabolites in hepatocytes. The environmental exposure to aflatoxins in foods or feeds may be reflected on the level of circulating aflatoxin [AFB1] in blood. The levels of albumin-abducted AFB1 were measured using a quantitative ELISA test in the sera of 80 Egyptian patients diagnosed as HCC, 40 HCV infected non malignant subjects and 40 healthy control individuals. The mean value of albumin-abducted AFB1 in the sera of HCC patients was significantly higher than the control groups [P< 0.05]. Farmers coming from rural areas had significant rise in the AFB1 compared to other patients coming from urban areas or having other jobs [P< 0.01]. The level of AFB1 was noticed to be significantly higher in patients having multiple lesions and also in patients presenting with tumor sizes more than 5 cm [P< 0.05]. HCV antibody and/or RNA were detected in all examined HCC patients. Exposure to environmental aflatoxin seems to be a major risk factor for HCC in HCV-infected Egyptians. HCV chronic hepatitis could render the liver less capable of intoxication and removal of AFB1 from the body. Then the accumulated AFB1 may induce mutation in p53 paving the way for HCV to induce HCC