Bacterial and parasitic profile of acute infectious pediatric diarrhoea and the role of faecal screening tests in prediction of the invasive type of diarrhoea

Diarrhoea is one of the leading causes of morbidity and mortality in children worldwide. Faecal screening methods as detection of faecal leucocytes, faecal lactoferrin and faecal occult blood, have diagnostic and therapeutic implications in the provisional diagnosis of invasive diarrhea before culture results made available. Aim of the work was to outline the bacterial and parasitic profile of acute pediatric diarrhoea and to evaluate faecal screening test in preliminary diagnosis of invasive diarrhoea. Three hundred children under five years of age, suffering from acute diarrhoea [<4 days] and attending the out-patient clinic of El Shatby Children's University Hospital in Alexandria over a period of 1 year, were recruited in the study. Stool samples were collected from the children and were subjected to bacteriological examination, parasitological examination and 3 faecal screening tests to distinguish invasive [inflammatory] from non invasive [non inflammatory] diarrhoea. Forty eight percent of samples were positive for enteric pathogens. Enteric bacterial pathogens were isolated from 25% of samples. Parasites 29% and mixed bacterial and parasitic infections were detected in 6% of samples. Enterotoxigenic E.coli [ETEC] was the most common bacterial isolate detected in 10% of samples, followed by Salmonella [8%], Shigella [6.67%] Campylobacter [5%] and Vibrio parahaemolyticus [1.33%]. Cryptosporidium was the most commonly identified parasite [13%] followed by Giardi lamblia [11%], Entamoeba histolytica [8%] and Cyclospora cayetanensis [3%]. Ascaris lumbricoides and Haeminolipus nana were only identified in 1% of samples, each. The gold standard for evaluation of faecal screening tests was positive culture for invasive bacterial pathogens and/or positive E. histolytica on microscopic examination of stool samples. Leuko test had the highest sensitivity [85.54%], specificity [73.73%], positive predictive value [55.47%], negative predictive value [93.02%] and accuracy [77%]. False positive results of the Leuko-test were significantly higher in the breast-fed children than non breast-fed ones [26.7%, 11.7% respectively, p<0.01]. Better sensitivity, specificity, positive and negative predictive values of the Leuko-test was recorded in the non breast-fed children than in the breast-fed ones. The recorded values in the first group were: 91.11%. 83.64%, 69.5% and 95.83%, respectively compared to 78.95%, 63.55%, 43.48% and 89.47% respectively in the second group. The study concluded that, Leuko test is the best applicable faecal screening test in differentiation of invasive and non invasive diarrhoea but is better avoided in breast-fed infants as many false positive results might be interpreted

Surveillance of healthcare-associated infections in adult patients with leukemia in Kuwait cancer control center

To study the incidence, types and microbial etiology of healthcare-associated infections affecting adult patients with leukemia and the antimicrobial susceptibility of Gram-negative bacteria to ciprofloxacin. Prospective study. Kuwait Cancer Control Center [KCCC], Kuwait. All adult patients suffering from different types of leukemia, managed in the Hematology-Oncology unit over a period of 15 months [January 2006 - March 2007]. Prospective surveillance of healthcare-associated infections. Overall incidence density rate of healthcare-associated infections was 13.4/1000 patient days. Patients suffering from acute myeloid leukemia [AML] had the highest infection rate [16.2/1000 patient days]. The rates were significantly higher in acute types of leukemia than chronic ones [p = 0.001]. Infections develop significantly more in female patients [p < 0.001]. The most frequently reported infections were blood stream infections [BSI, 46.9%] followed by skin and soft tissue infections [SST, 25.7%]. Eighty-three percent of BSI was central line-associated. Gram-negative bacteria, Gram-positive bacteria and fungi were isolated from 69.9, 18.6 and 4.4% of all infections respectively. Escherichia coli [E. coli] were isolated from 35.2% of all microbiologically-documented infections followed by Pseudomonas aeruginosa [15.2%]. Majority of the isolated Gram-negative bacteria were ciprofloxacin resistant including E. coli, with 97.3% resistance to ciprofloxacin. Majority of the infections [80.5%] were associated with a neutrophil count of < 500 cell/mm[3] in patients receiving ciprofloxacinprophylaxis. Infections remain a major complication in adults with acute leukemia. Continuous monitoring of the rate of Gram-negative bacteremia is recommended for timely detection of the loss of efficacy of fluoroquinolone prophylaxis

Comparison between the broth microdilation and disc diffusion techniques in testing the susceptibility of candida albicans to flucanazole

Antifungal drug susceptibility testing has become more important due to the increase in serious fungal infections and the concomitant emergence of resistance to antifungal agents. The reference methods for antifungal susceptibility testing are cumbersome, costly, and reading the endpoints of the azoles [as fluconazole] is difficult. Rapid, easy, reproducible, and inexpensive alternative methods of obtaining susceptibility data are needed. Hence, this study aimed at determination of the susceptibility patterns of clinical isolates of Candida albicans [C. albicans] to fluconazole [FLC] and comparison between the reference broth microdilution and disk diffusion methods [using two different agar media] for antifungal susceptibility testing. The study was carried out on 70 clinical C. albicans isolates [from 60 different cutaneous lesions in otherwise healthy patients and 100 immunocompromised patients complaining from symptoms of urinary tract infections]. Antifungal susceptibility testing of isolates was performed by the reference broth microdilution method and by the disk diffusion method on Yeast extract peptone dextrose [YEPD] agar and Mueller-Hinton agar supplemented with 2% glucose and 0.5 micro g/ml of methylene blue [MHGM] using 25-micro g FLC disk. The results revealed that, by the reference method 95.8%were susceptible [5], 1.4% was susceptible-dose dependent [S-DD], and 2.8% were resistant [R]. All the cutaneous isolates were susceptible to FLC compared to only 88% of the urinary ones. Comparison between MIC categories of the broth method and 24-h disk test categories on MHGM showed that, the observed agreement was 98.6%. When S-DD and R were considered as one category [non susceptible], the observed agreement increased to reach 100%[perfect agreement, k=1, p=0.000]. After 48-h incubation the observed agreement declined to 97.1%. When susceptible and non susceptible categories were considered, the observed agreement reached 98.6% [excellent agreement] [k=0.85, p=0.000]. On YEPD agar, the observed agreement was 97.1% [good agreement, k=0.74]. After 48-h, the observed agreement declined to 92.9% [fair agreement, k=0.51, p=0.000]. The inhibition zones had clear and definite margins in 97.1% of isolates on MHGM compared to 85.7% on YEPD. In conclusion, FLC has perfect antifungal effect on C. albicans isolated from cutaneous lesions in otherwise healthy patients while some of its activity is lost in isolates from the immunocompromised patients. The 25-micro g fluconazole disk diffusion technique using MHGM agar interpreted after 24h correlated well with the reference microbroth method. Moreover, it is rapid, simple, convenient, cost effective, less subjective and less cumbersome than the reference method. Hence, FLC should be prescribed with caution and on strict indications to reduce the potential development of resistance. The use of FLC disk diffusion susceptibility testing of C. albicans on MHGM agar read after 24h could be recommended as an alternative to the reference micro- dilution method in routine practice

Importance of mycological confirmation of clinically suspected cases of Tinea corporis, Tinea pedis and Tinea cruris

Tinea corporis, tinea cruris, and tinea pedis are of the most prevalent dermatophytoses. Several conditions that mimic dermatophytoses and atypical and steroid modified forms of the disease usually present difficulties in diagnosis. Hence, the present investigation aimed at studying these conditions on mycological basis. The study included 163 cases clinically diagnosed as having tinea corporis, tinea pedis or tinea cruris. Specimens were taken by skin scraping. Samples were cultured on Sabouraud's dextrose agar and examined microscopically. The results revealed that, only 90.8% of cases were mycologically proven [positive by one or both methods]. Most of tinea corporis, tinea pedis and tinea cruris cases [68.9%, 79.1% and 83.9% respectively] were diagnosed by both methods [P>0.05]. For cases of tinea corporis and tinea cruris, males were more than females [51.4%, 48.6% and 58.1%, 41.9% respectively] while females exceeded-males [72.1%, 27.9% respectively] in cases with tinea pedis [P<0.05]. Trichophyton rubrum [T.rubrum] was the most common isolate in all the studied conditions, represented 64.9% in tinea corporis, 53.4%, for tinea pedis and 64.6% for tinea cruris. T.mentagrophytes var interdigitale was mostly isolated from cases of tinea pedis [23.3%].The majority of T.violaceum was isolated from cases of tinea corporis [12.2%].The main isolation of E.floccosum was from cases of tinea cruris [16.1%] Microsporum canis [M. canis] was only isolated from one case [1.4%] of tinea corporis while Candida albicans [C.albicans] alone [9.3%] or with T.rubrum [7.0%] was isolated only from cases of interdigital tinea pedis. [P<0.05].The majority of cases of tinea corporis, tinea pedis and tinea cruris had chronic lesions [78.4%, 76.7% and 54.8% respectively] [P<0.05] and received prior therapy for the condition 79.7%, 76.7% and 58.1% respectively, [P>0.05]. In conclusion, early accurate diagnosis [on mycological basis] is an important tool to control and reduce the incidence of dermatophytosis. Periodic epidemiological analysis of these conditions is required to ensure their efficacious control

Prevalence and possible risk factors of helicobacter pylori infection among children attending Damanhour teaching hospital

Helicobacter pylori [H. pylori] is a major cause of gastrointestinal disease in children. The factors influencing the acquisition and prevalence of H. pylori infection remain incompletely understood. In the present study, the prevalence and possible risk factors of H. pylori infection were studied among children aged 1.5-16 years who were attending the pediatric outpatient clinic of Damanhour Teaching Hospital. Blood samples were drawn and IgG seroprevalence of H. pylori among the studied children was determined using ELISA kits. A specially designed questionnaire inquired about personal, socioeconomic, household characteristics, feeding history during infancy and the child's health data was completed for every child. Results revealed that the overall seroprevalence of H. pylori infection was 50.5%. The prevalence was widely age dependent: it was 60.6% among those age >/= 5 years and only 25.9% among those <5 years [OR=4.4; 95% C1=1.6-11.9]. Increased crowding in bed was also an associated factor; the prevalence among children where >/= 3 share a bed was 59.7% compared to only 26.9% among those where /= 1 year [OR=2.5; 95% CI=1.1-5.9]. After controlling for possible confounding in a Stepwise Multiple Logistic Regression model, independent predictors for H. pylori infection were: increasing age [>/= 5 years], overcrowding in bed [>/= 3/ bed] and shorter duration of breast-feeding [<1 year] during infancy. It could be concluded that, H. pylori was highly prevalent among the sampled children and the possible risk factors are related to the community. So, there is a need to early diagnose, treat and eradicate infection during childhood to prevent its complications during adulthood

role of drinking water and gut flora in dissemination of multiple-antibiotic resistance

This work aimed at studying the antibiotic resistance pattern of the gut and drinking water E. coli. Stool samples from 205 primary school children were cultured for isolation of gut E. coli. Drinking water samples from household taps, public taps and storage pots [Zeer] were collected and examined for the presence of E. coli using the standard membrane filter technique. All the isolated E. coli were tested for their susceptibility to the following antibiotics: Ampicillin, sulfamethoxazole-trimethoprim, gentamicin, chloramphenicol, tetracycline, nalidixic acid, nitrofurantoin, ceftriaxone and ciprofloxacin. Out of the stool isolated E. coli, 78.5% were MAR. E. coli was isolated from 61.3% of the stored Zeer water of which the majority were MAR. The resistance was high to the community-used antibiotics, while the hospital-used agents still retained their efficacy