Changes in susceptibility pattern of streptococcus pneumonia at Tawam Hospital in Al Ain, United Arab Emirates during [2004-2011]

Objective: Objective of the study was to find out the prevalence and antimicrobial susceptibility pattern of Streptococcus pneumoniae isolates at local hospital

Study Design: Retrospective study

Place and Duration of Study: Microbiology department of Tawam hospital isolates from 2004-2011

Material and Methods: A total of 1066 isolates of Streptococcus pneumoniae were obtained from various clinical specimens at Microbiology section of Department of Laboratory Medicine, Tawam hospital, Al Ain, United Arab Emirates, from the period stretching over eight calendar years; 2004- 2011. We examined the data of all the S. pneumoniae isolates from the different body sites since 2004 until 2011, there were changes in the antibiotic susceptibility interpretation of S. pneumoniae to some antibiotics especially penicillin and ceftriaxone. For this study purpose, the 2011 CLSI guidelines is used retrospectively to interpret the antibiotics susceptibility for all the isolates [2004-2011]

Results: The total number of isolates per year remained stable [p = 0.957]. The number of isolates from blood showed a significant increase [p<0.05]. During the period [2009-2011], most of the isolates were from the pediatric patients [<1-15 years of age] and the elderly [51-95 years old]. The isolates were fully sensitive to levofloxacin and vancomycin. There was no significant change in sensitivity to tetracycline, and trimethoprim/ sulphamethaxazole. Until 2010, there was a significant drop in sensitivity to erythromycin [p=0.001, OR= 0.8]. In 2011, though insignificant, susceptibility dropped to 47.4%. There was a significant drop in sensitivity to chloramphenicol [p<0.05, OR 1.2] and clindamycin [p<0.05, OR =0.7]. Only 41.3% isolates were sensitive to penicillin G [meningitis] in 2004, which remained fairly the same until 2011, when it was 40.2%. In case of other body sites, the isolates sensitive to penicillin G [non- meningitis] were 98.4% in 2004 and 98.3% in 2011. The sensitivity to ceftriaxone [meningitis] dropped significantly from 93.3% to 81.2%. [p<.001 and OR=0.7]. The isolates sensitivity to ceftriaxone [non-meningitis] dropped significantly as well from 99.2% in 2004 and 96.6% in 2011 [p=.014, OR=0.6]. There was no significant change in reduced sensitivity to penicillin G for meningitis and non-meningitis. There was a significant increase in the intermediate sensitivity of S. pneumoniae isolates to ceftriaxone [meningitis] from 5.8% in 2004 to 15.4% in 2011 [p<.001 and OR= 1.3] and ceftriaxone [non- meningitis] from 0.8% to 3.4%.[p<.001 andOR=1.4]

Conclusions: The resistance of S. pneumoniae to ceftriaxone, erythromycin, chloamphenicol and clindamycin is increasing

Dengue fever outbreak: a clinical management experience

To determine the frequency of dengue as a cause of fever and compare the clinical and haematological characteristics of Dengue-probable and Dengue-proven cases. An observational study. The Combined Military Hospital, Malir Cantt., Karachi, from August 2005 to December 2006. All patients with age above 14 years, who were either hospitalized or treated in medical outdoor clinic due to acute febrile illness, were evaluated for clinical features of Dengue Fever [DF], Dengue haemorrhagic fever [DHF] and Dengue Shock Syndrome [DSS]. Patients showing typical clinical features and haematological findings suggestive of Dengue fever [As per WHO criteria] were evaluated in detail for comparison of probable and confirmed cases of Dengue fever. All other cases of acute febrile illness, not showing clinical features or haematological abnormalities of Dengue fever, were excluded. The clinical and laboratory features were recorded on SPSS 11.0 programme and graded where required, for descriptive and statistical analysis. Out of 5200 patients with febrile illness, 107[2%] presented with typical features of DF, 40/107[37%] were Dengue-proven while 67/107[63%] were Dengue-probable. Out of Dengue-proven cases, 38 were of DF and 2 were of DHF. Day 1 temperature ranged from 99-1050C [mean 1010C]. Chills and rigors were noticed in 86 [80%], myalgia in 67%, headache in 54%, pharyngitis in 35%, rash in 28%, and bleeding manifestations in 2% cases. Hepatomegaly in 1[0.5%], lymphadenopathy in 1[0.5%] and splenomegaly in 12 [11.2%] cases. Leucopoenia [count < 4x109 /L] was noted in 73%, platelet count <150 x109 /L in 84% and ALT > 40 U/L in 57% cases. Frequency of clinically suspected dengue virus infection was 107 [2%], while confirmed dengue fever cases were 40 [0.8%] out of 5200 fever cases. Fever with chills and rigors, body aches, headache, myalgia, rash, haemorrhagic manifestations, platelet count, total leukocyte count, and ALT, are parameters to screen the cases of suspected dengue virus infection; the diagnosis cannot be confirmed unless supported by molecular studies or dengue specific IgM

Onest of adult varicella in relation to rural or urban origin and its complications

To determine area of origin of adult varicella patients, whether rural or urban, to compare the mean interval between leaving the area of origin and onset of varicella in adults of rural origin in comparison with those of urban origin and to observe its complications. A cross-sectional study. Combined Military Hospital, Abbottabad, from January to December 2006. All patients over the age of 18 years, presenting with acute illness clinically, suggestive of varicella were included in the study. A specially designed proforma was filled for each patient separately, which included demographic features as well as area of origin, whether rural or urban, and the age at which they left the area of origin. These patients were examined, treated and assessed clinically on regular basis for the progress of the disease as well as for its possible local or systemic complications. Data analysis was done by using statistical programme SPSS-10. Out of 9155 adult patients, 156 [1.70%] had varicella, including 128 [82.1%] males and 28 [17.9%] females. Origin was rural in 125 [80.1%] and urban in 31 [19.9%] patients. Mean interval between leaving area of origin and developing varicella in those of rural origin was 01.79+01.78 years and that in patients of urban origin was 03.37+05.72 years [p+0.009]. None of the patients developed any complication of the disease. Varicella in adults is generally a benign illness. It is more common among adult males of rural origin and the interval between leaving the area of origin and onset of varicella in these patients is significantly less as compared to that in adults of urban origin

Seropositivity of hepatitis delta virus in patients with chronic Hepatitis B virus infection

To determine the frequency of hepatitis delta virus [HDV] seropositivity in patients with chronic Hepatitis B Virus [HBV] infection at Armed Forces Institute of Pathology [AFIP], Rawalpindi. Study design: Cross-sectional study. The study was conducted at department of Virology, AFIP, Rawalpindi. A total of 227 serum samples were collected at AFIP, Rawalpindi, from patients with chronic hepatitis B virus [HBV] infection along with a short history regarding the age, sex and socioeconomic status. Enzyme Linked Immundsorbent Assay [ELISA] for detection of HDV Immunoglobulin G [IgG] and Immunoglobulin M [IgM] antibodies was performed on all the collected serum samples. A total of 30 [13.2%] patients out of 227, were found positive for IgG. The mean age of the patients was 35.8 +/- 10.7 years. Seropositivity of HDV-IgG was 12.8% [25/195] in males and 15.6% [5/32] in females. 11.8% [6/51] of patients from higher socioeconomic group and 13.6% [24/176] in lower socioeconomic group were positive for HDV-IgG [p=0.728%]. Our study shows that 13.2% of chronic hepatitis B virus infected patients at AFIP, Rawalpindi, were positive for HDV IgG. HDV seropositivity was not affected by demographic variables-such as age, gender and socioeconomic status of patients

Seroprevalence of hepatitis B, C and HIV in healthy blood donors in northern Pakistan

To determine the seropositivity for viral hepatitis B, hepatitis C and HIV in healthy blood donor population of Northern areas of Pakistan. The blood donors attending the blood bank of Hayatabad Medical Complex, Peshawar were screened for seromarkers of viral hepatitis B, C and HIV by using enzyme linked immunoassay [ELISA] over a period of 05 years. The data of blood donor screening was obtained from Services Hospital, Peshawar for comparison. Blood donors screened at H.M.C. Hospital showed seropositivity of 1.40% and 1.34% for hepatitis B and hepatitis C respectively from 1999 - 2003. Screening of blood donors at Services Hospital, Peshawar during the same period, detected 1.75% HBsAg positive and 2.60% anti-HCV positive subjects. No HIV positive blood donor was detected in both the hospitals during this period. This study concluded a decreasing trend in the seroprevalence of viral hepatitis [B and C] in the blood donor population of Northern Pakistan

Hepatitis B viral load in various categories of chronic hepatitis B carriers

To determine serum hepatitis B virus [HBV] DNA levels by Real-time Polymerase chain reaction [PCR] in different categories of treatment-naive patients with chronic HBV infection in context with Hepatitis B serology and serum Alanine aminotransferase [ALT] levels. Cross-sectional study. A total of 122 chronic hepatitis B carriers, including 79 low grade carriers [Anti-HBe positive HBeAg negative], 40 high grade carriers [HBeAg positive, Anti-HBe negative] and 3 intermediate grade carriers [Both HBeAg and Anti-HBe negative] were evaluated for HBV DNA levels and serum ALT levels. The serum HBV DNA levels of the low grade carriers with normal ALT levels [<40 IU/L] were significantly lower than the low-grade carriers with raised ALT levels [mean viral load 3x10[3] vs. 1.6x10[6] copies/mL; p=0.0003]. The HBV DNA levels of the high grade carriers were significantly higher than those of the low grade carriers with normal ALT levels [mean viral load 6.4x10[7]vs. 3x10[3] copies/mL; p=0.0007] and than those of low grade carriers with raised ALT levels [mean viral load 6.4x10[7] vs. 1.6x10[6] copies/ mL; p=0.03]. The results show that HBV DNA levels vary in different categories of chronic hepatitis B carriers and when evaluated by a sensitive quantitative PCR assay the HBV DNA levels can be used for differentiation between HBeAg-negative chronic hepatitis B and inactive hepatitis B surface antigen carrier state

Hepatitis A virus infection - shifting epidemiology

To determine the age distribution in HAV infection and seasonal variations in the prevalence of acute viral hepatitis caused by hepatitis A virus. A descriptive study. The study was carried out on the patients reporting at Virology Department, Armed Forces Institute of Pathology [AFIP], Rawalpindi, for determination of hepatitis A virus [HAV] IgM antibody, from July 2003 to June 2004. Altogether 626 patients with clinical suspicion of hepatitis A virus infection were referred to AFIP Rawalpindi for this test. Blood samples were collected and sera were separated and transferred to plastic aliquots that were stored at -20oC in a retrievable fashion until utilized in testing. The testing for ant-HAV IgM was carried out with the help of a commercial Enzyme Linked Immunosorbant Assay [ELISA] using reagent kits of DiasSorin [Germany] for HAV IgM antibodies. The HAV IgM positive rate was 40.57% [252/626]. Those tested included the sporadic cases as well as the patients from outbreak in two schools of Nowshera cantonment. The age of patients testing positive for HAV IgM, ranged from 03 to 27 years. There was a statistically significant seasonal difference in rate of positivity in different months of the calendar year. An outbreak of HAV infection was seen in the children of two neighboring schools of a cantonment, in which 44 children in different classes developed clinical jaundice. HAV infection occurs in a significant proportion of young people with a clinical suspicion of HAV infection. There is a changing trend of developing hepatitis A in the age beyond 18 years and in outbreaks, which was not there in our patients previously due to universal immunity found against HAV by the age of 18. It was because of chances of consumption of polluted food

Chicken pox associated thrombocytopenia in adults

To determine the frequency and magnitude of thrombocytopenia associated with chicken pox in adults. Observational descriptive study. Combined Military Hospital, Attock, from July 2003 to June 2004. All patients of age 15 years and above with history of fever, followed by appearance of the typical vesicular chicken pox rash, were inducted after informed consent. Two milliliters of whole blood was collected on day 1 of admission, and blood counts were performed. Patients were admitted and given 800 mg oral acyclovir, 5 times/day, for 7 days, in addition to symptomatic treatment. Patients were followed till 8 weeks. A total of 410 patients of chicken pox were received, out of which 270 were included. Age of patients ranged between 15 and 40 years with median age of 21 years. Platelet count on the day of admission ranged between 29 x109/L to 513 x109/L, mean platelet count 178 x109/L. Platelet count < 150 x109/L was detected in 80/270 [30%] patients. Platelet count in thrombocytopenia patients was from 29 x109/L to 149 x109/L with mean 121 x109/L. Thrombocytopenia recovered within 02 weeks in 78/80 [97%] patients. In 2 patients, thrombocytopenia recovered in 3 weeks. None of the patients developed purpuric spots, ecchymosis or bleeding manifestations. Thrombocytopenia in chicken pox is a common entity. Platelet count remains above 25x109 /L, which is usually not associated with bleeding manifestations. None of the patients in this series developed purpura. No specific pattern of total leukocyte counts was predictive of the progression or regression in platelet count

Seroprevalence of hepatitis B and C in young adults seeking recruitment in Armed Forces

Hepatitis B virus [HBV] and hepatitis C virus [HCV] are the commonest causes of chronic liver disease all over the world including Pakistan. According to the Pakistan Armed Forces policy, all the military recruits are now screened for the Hepatitis B surface antigen [HBsAg] and antibodies to Hepatitis C virus [Anti-HCV] before induction. Previous studies have shown a wide variation in the results regarding the prevalence of HBV and HCV infections. We analysed sera of 15550 young adults seeking recruitment in Armed forces for the presence of HBsAg and Anti-HCV. Sera of healthy adult individuals who presented for medical evaluation as prerecruitment criteria in the Punjab Regiment Centre, Mardan, were tested for presence of hepatitis B surface antigen [HBsAg] and anti-hepatitis C virus [Anti-HCV] by rapid method. Positive cases were confirmed by ELISA technique from Armed Forces Institute of Pathology [AFIP] Rawalpindi. A total of 15550 individuals were examined. Out of these, 504 [3.24%] individuals had positive HBsAg whereas 574 [3.69%] were positive for anti-HCV. Hepatitis B surface antigen and anti-HCV both were found in 49 [0.31%] individuals. This study which evaluated predominantly healthy young male population, showed a high seroprevalence of anti-HCV than Hepatitis B surface antigen. Although there is downward trend in prevalence of hepatitis B, there is considerable threat of HBV and HCV to our younger population and there is a genuine need for strict adherence to preventive measures

Outbreak of dengue fever in Mangla and Mirpur area

Dengue virus infection has been endemic in Pakistan. An outbreak of febrile illness associated with thrombocytopenia was reported from Mangla and adjoining areas in vicinity of Mangla Dam during July-August 2003. We carried out a serological investigation of the outbreak by serosurveillance. Sera from 52 representative cases were received for viral studies at our institute. Aim of the study was to rule out dengue infection in these cases. Descriptive laboratory based. Department of Virology, Armed Forces Institute of Pathology, Rawalpindi. According to clinical history all the, patients had fever of 3-10 days duration associated with thrombocytopenia. Suspecting Dengue infection, their acute sera were tested for Dengue IgM, by the kit manufactured by Diagnostic Automation Inc., Dengue virus IgM ELISA USA. Among 52 single sera from these cases. Dengue IgM antibodies were detected in 38[73%] cases. Among the sero-positive cases, 7[18.4%] had Vivax malaria. 32[84%] were males with mean age of 34 years and 6[16%] were females with mean age of 27 years. Platelets were below 150,000/micro l in all the cases. Occurrence of Dengue fever in northern Pakistan has been documented and this should now be considered in the differential diagnosis of undiagnosed cases of fever, moreover concomitant malaria infection emphasizes the need for sustainable, community-based mosquito control

Prevalence of hepatitis B and C in a healthy cohort

Hepatitis B virus [HBV] and hepatitis C virus [HCV] are the commonest causes of chronic liver disease all over the world including Pakistan. Earlier studies show wide variation in the results regarding the positivity of HBV and HCV infections [total number 665] in different groups of Pakistani populations. Prospective, descriptive. July-September 2004, Combined Military Hospital, Khuzdar and Armed Forces Institute of Pathology [AFIP], Rawalpindi. Healthy adults belonging to different areas of Pakistan were screened for Hepatitis B surface antigen [HBsAg] and anti-Hepatitis C virus antibodies [Anti-HCV] by rapid method and positive cases were confirmed by ELISA from Armed Forces Institute of Pathology [AFIP] Rawalpindi. The sero-positivity of anti-HCV was found to be 3.3% and that of HBsAg was 3%. There was wide variation in prevalence of anti-HCV and HBsAg in different areas of Pakistan. This study indicates that although there is trend toward decline in prevalence of hepatitis B, there is considerable HCV and HBV threat to our population and there is a genuine need for strict adherence to preventive measures