Human immunodeficiency virus type-1 [HIV-1] disease progression and viral activity: a seroepidemiological and molecular study

To determine the frequency and epidemiological characterization of human immunodeficiency virus type-1 [HIV-1] infection, HIV disease progression, immune status and viral activity. Descriptive study. Department of Microbiology, University of the Punjab and Institute of Public Health, Lahore, from September 2005 to August 2008. The study enrolled samples from general population, high risk groups and spouses of HIV+ deport workers with criteria; positive double enzyme linked immunosorbent assay [ELISA] and positive western blot. Immune status and viral activity was determined by cluster determinants [CD4+ and CD8+] cell count, ratio of CD4+/CD8+ on flow cytometer, and HIV RNA viral load on polymerase chain reaction [PCR]. A total of 116 HIV+ untreated subjects enrolled after screening of 2260 blood samples. The seroprevalence rate in general population, high risk individuals and spouses of HIV+ deport workers was found 0%, 0.4% and 26% respectively. The CD4+ cell count was found 533/mm[3] [range 12-1800/mm[3]] and plasma viral load 27,122 copies/ml [range 00-40,621]. The CD4+/CD8+ ratios < 0.5, < 1, < 1.5 and < 2 appeared as 17.2%, 30.2%, 51.7% and 0.9% respectively. Significant correlation was observed between plasma viral load, CD4+ count and CD4+/CD8+ ratio [p = 0.001]. CD4+ T-cell counts < 200 cells/mm3 was found in 23 HIV+ patients. There was a low frequency of HIV in the general population and high risks groups as compared to very high frequency in spouses of HIV+ deport workers with significant correlation of viral activity and immune status

Antimicrobial susceptibility pattern of Staphylococcus aureus on clinical isolates and efficacy of laboratory tests to diagnose MRSA: a multi-centre study

The global problem of increasing trend in antimicrobial resistance is particularly pressing in the developing countries, where the Methicillin-Resistant Staphylococcus aureus [MRSA] is often the severe casual agent in hospital-acquired infections. This multi-centre surveillance prospective study was planned to define the magnitude of problem of MRSA among clinical isolates from four teaching hospitals of Lahore Pakistan; Mayo, Services, Jinnah and Shaikh Zayed Hospitals during April 2006-March 2008. Identification of organisms was done by the standard Microbiology methods. MRSA isolates identified on Kirby-Bauer disc diffusion were further evaluated by minimum inhibitory concentration on BD PhoenixTM system and detection of mecA gene by pulsed-field gel electrophoresis [PFGE] PCR. Of the total 1,102 S. aureus isolates, oxacillin resistance was found in 462 on disc diffusion and 420 on MIC while mecA gene was detected from 307 strains. The prevalence of MRSA among S. aureus isolates was 41.9%, 38.1% and 27.9% on disc diffusion, MIC, and mecA gene detection respectively. Hospital acquired-MRSA strains were multi drug resistant while community acquired-MRSA showed susceptibility to clindamycin [63%], ciprofloxacin [24.2%] and SMZ/TMP [3.9%]. In diagnosing MRSA, the sensitivity and specificity rates of disc diffusion test were 100% and 83.7% while MIC 96.2% and 93.3% respectively. There is an increasing trend in emergence MRSA and the conventional method of antimicrobial susceptibility testing showed false positive tests. This is the reason of misuse of vancomycin by physicians which may further increase MRSA in Pakistan. Therefore, molecular diagnostic facilities are recommended to avoid falsesusceptible results

Legionella infection; an environmental and clinical study during hajj season

Respiratory system is most commonly affected during Hajj season. [1] to determine the prevalence of Legionella in drinking water, cooling sprinklers and other sources of water consumed in pilgrimage area of the holy city, Makkah; [2] to study the prevalence of pneumonia caused by Legionella species from clinically suspected cases; and [3] to determine whether there is any relationship disease incidence and water supply system. The clinical samples were received from in-patients of the following five Ministry of Health [MOH] Hospitals; Hera General Hospital, Al-Noor Specialist Hospital, King Faisal Hospital, King Abdul-Aziz Hospital, and Ajyad Hospital during Hajj 2003. The patients included in the study were those who fulfilled the following criteria; clinically diagnosed as pneumonia, negative on routine cultures and found negative for acid fast bacilli [AFB] from sputum/bronchial aspirate [BAL]. Serological tests was done by Enzyme linked Immunosorbent assay [ELISA] for Legionella antibodies total lgG and IgM. Out of total 133 patients suspected for Legionella, 83 [62.4%] were male and 50 [37.6%] female. The male versus female ratio was 1:0.6. The major age group affected was between 50-70 years [63.2%]. There were 4 [3.0%] cases of Legionella species isolated from microbiological cultures. The overall seropositive rate among clinically suspected cases was 4.51%. A total of 560 water samples were collected from Arafat, Muzdalifa, Mena, and areas around the Holy Mosque and found negative for Legionella species. Pneumonia was one of the most common illnesses among pilgrims. The water supplied to all areas of the pilgrimage was free from the Legionella and no link has been established among the patients with water supply systems. Both clinicians' awareness and availability of specialized laboratory tests for atypical pneumonia such as Legionella is necessary. Although, all water samples found negative for Legionella but it is recommended to screen all water reservoirs for Legionella annually before Hajj season

Systemic lupus erythematosus [SLE] in Makkah, Saudi Arabia

To describe the clinical features, laboratory diagnosis, treatment and course of systemic lupus erythematosus [SLE] as seen in Makkah, Saudi Arabia. Retrospective study. Rheumatology Unit, Hera General Hospital, Makkah, Kingdom of Saudi Arabia. Patients fulfilling the "revised 1982 American College of Rheumatology [ACR] criteria for SLE" were included. The clinical features, laboratory investigations and radiological findings were recorded. Drug treatment comprised of prednisone, chloroquine, azathioprine and non-steriodal anti-inflamatory drugs [NSAID] singly or in combination. Cyclophosphamide pulses were given to patients with major organ involvement. Atotal of 54 patients were enrolled in our study. Fifty three [98.1%] were female. The female versus male ratio was 53:1. The mean age at diagnosis was 30.08 years [ +/- 10.09 SD] and the range was 10-59 years. 96.3% patients were Saudis, whereas 3.7% were non-Saudis. The main features were: malar rash [22.22%], discoid rash [5.6%], photosensitivity [24.1%], oral ulcers [42.6%], alopecia [29.6%], arthritis [35.2%], serositis [16.7%], renal disorders [42.6%], neuropsychiatric disorders [33.33%], hematological disorder [68.51%], immunological disorders [85.19%] and positive antinuclear antibodies in 87% cases. The course and presentation of SLE in our study was comparable to that seen in earlier studies from the Arabian Peninsula. However, in our series, the incidence of arthritis was lower and that of oral ulcers was higher than reported. The major age group affected by SLE was 30-39 years. Extreme female preponderance and high number of patients per year were the main demographic characteristics of our study