In Vitro efficacy of ethionamide and clarithromycin in mycobacterium tuberculosis isolates

To determine the sensitivity of clinical isolates of Mycobacterium tuberculosis isolates against ethionamide, and clarithromycin. Cross-sectional study. Department of Microbiology, Armed Forces Institute of Pathology [AFIP] Rawalpindi from June 2003 to June 2004. All routine clinical samples received for acid fast bacilli [AFB] culture and yielding positive growth on Lowenstien Jensen medium and Bactec 460 were included in the study. The isolates were from sputum [n=70], bronchioalveolar lavage [n=10], fine needle aspiration [n=6], lymph nodes [n=7], pleural fluid [n=4], endometrium [n=3]. After the identification of M. tuberculosis [MTB] sensitivity was performed against first-line antituberculosis drugs. Then susceptibility of M. tuberculosis isolates against ethionamide and clarithromycin was performed on LJ medium. Mycobacterium H37Rv was used as control strain. Results were interpreted using resistance ratio method. Out of 100 M. tuberculosis isolates, sensitivity to ethionamide was 93% and 9% to clarithromycin. Clarithromycin when used alone is ineffective as antituberculosis drug but its efficacy in combination needs to be tested. However ethionamide may be used as an alternative antituberculosis drug

Morphological spectrum of gastric lesions - endoscopic biopsy findings

A retrospective study was carried out to determine the morphological spectrum of gastric lesions at Pathology Department of Army Medical College, Rawalpindi for the duration of 02 years. Descriptive Study. The gastric mucosal biopsies of 787 patients received from Gastroenterology unit of Military Hospital Rawalpindi from January 2002 to December 2003, were studied by routine histopathology methods. A high frequency of gastric disease in males with a male to female ratio of 6:1 and an age range of 09 years to 85 years were observed. The clinical presentations mostly seen were abdominal pain, dyspepsia, vomiting, diarrhoea, decreased appetite and weight loss. On endoscopy the most frequently suspected lesions were gastritis 662[84.12%], stomach growth 45[5.72%], gastric ulcers 10[1.27%], while 70[8.89%] cases showed unremarkable mucosa. The histopathology revealed chronic non-specific gastritis 676[85.89%] followed by malignant tumours 45[5.72%], benign neoplasms 3[0.38%] and gastric ulcer 10[1.27%]. A number of biopsies 53[6.73%] were unremarkable histologically. The more prevalent lesions in this series were chronic active gastritis followed by tumours and gastric ulcers. H. pylori associated gastritis was seen in majority of the patients. Thus gastric biopsy is an essential tool for diagnosis and confirmation of clinically suspected cases

Changing frequencies and current status of multiple-drug resistant typhoidal salmonellae in year 2001-2003 at Rawalpindi

Typhoid fever is endemic in developing countries. Multiple drug resistant [MDR] typhoidal salmonellae are on the rise worldwide. We carried out a study in our setup to determine the changing frequencies of typhoidal salmonellae and to highlight their current antibiotic resistance patterns. The study was carried out on 15611 blood samples of admitted patients with febrile illness from 2001 to 2003. The blood culture samples were subcultured on Blood Agar and MacConkey Agar. Non lactose fermenting colonies were identified for typhoidal salmonellae and confirmed by using API 20E galleries and standard serological methods. Antibiotic susceptibility testing was performed using Modified Kirby-Bauer disk-diffusion method on Mueller-Hinton Agar. A total number of 333 isolates of Salmonella typhi and Salmonella paratyphi A were isolated from blood samples. Multidrug resistance was found in 172 [51.65%] isolates. The combined frequencies of MDR Salmonella typhi and MDR Salmonella paratyphi A decreased from 55.14% in year 2001 to 31.25% in year 2003 showing a decreasing trend. No Salmonella paratyphi B and Salmonella partyphi C were isolated in our study. None of the isolate was resistant to ciprofloxacin, ofloxacin and ceftriaxone. From 2001 to 2003, a changing trend in frequencies of MDR typhoidal Salmonella and reemergence of Salmonella typhi has been observed as compared to Salmonella paratyphi A. ciprofloxacin, ofloxacin and ceftriaxone are the drugs of choice for MDR typhoidal Salmonellae

Antibiotic resistance in campylobacter jejuni in Rawalpindi and Islamabad. A preliminary study

To determine the antimicrobial resistance in Campylobacter jejuni isolated from stools of children suffering from diarrhoea/dysentery in our setup against the antimicrobials commonly used as empirical therapy. Study: A prospective cross sectional descriptive study. Place and duration of study: Department of Microbiology, Army Medical College and Military Hospital, Rawalpindi from 29 August to 29 November 2002. Patients and methods: The study was carried out on eighteen isolates recovered from one hundred stool samples of children up to the age of twelve years admitted with diarrhoea/dysentery in Military hospital, Rawalpindi. The samples were collected in clean polypropylene containers containing Cary Blair medium. These were transported to the Microbiology Department, Army Medical College, Rawalpindi within 1-2 hours. The samples were inoculated on Modified Preston [Oxoid] and Karmali media [Oxoid] beside other routine stool culture media. The cultures were incubated at 42oC under microaerophilic conditions. The growth after 48 hours was provisionally identified by colonial morphology, oxidase test, Gram staining and motility. The organisms were identified to species level by hippurate hydrolysis, urease test, nitrate reduction, catalase test, H2S production, resistance to cephalothin and sensitivity to nalidixic acid. Sensitivity testing was carried by Modified Kirby Bauer disc diffusion technique on lysed horse Blood Agar against ampicillin [10 ug], erythromycin [15ug], tetracycline [10ug], chloramphenicol [30ug], trimethoprim/ sulphamethoxazole [1.25ug/23.75ug], nalidixic acid [30ug] and ciprofloxacin [5ug]. One isolate [7.14%] was resistant to ciprofloxacin, three [16.66%] to chloramphenicol and four [22.22%] to nalidixic acid, five [27.77%] to erythromycin, seven [38.88%] to tetracycline, sixteen [88.88%] to trimethoprim/sulphamethoxazole and ampicillin respectively. The susceptibility pattern reflects variable susceptibility with maximum resistance to ampicillin and trimethoprim/sulphamethoxazole. Four isolates were resistant to nalidixic acid

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